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Ghezzi A, Rossi J, Cavallieri F, Napoli M, Pascarella R, Rizzi R, Russo M, Salomone G, Romano A, Iaccarino C, Froio E, Serra S, Cozzi S, Giaccherini L, Valzania F, Pisanello A. Case Report: Pituitary metastasis as a presenting manifestation of silent gastric cardia adenocarcinoma. Front Oncol 2023; 12:1059361. [PMID: 36686817 PMCID: PMC9846627 DOI: 10.3389/fonc.2022.1059361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Pituitary metastases are very rare in cancer patients and often originate from lung or breast tumors. They usually occur in patients with known metastatic disease, but rarely may be the first presentation of the primary tumor. Methods We present the case of a 58 years-old-man who reported a three-month history of polyuria-polydipsia syndrome, generalized asthenia, panhypopituitarism and bitemporal hemianopsia. Brain-MRI showed a voluminous pituitary mass causing posterior sellar enlargement and compression of the surrounding structures including pituitary stalk, optic chiasm, and optic nerves. Results The patient underwent neurosurgical removal of the mass. Histological examination revealed a poorly differentiated adenocarcinoma of uncertain origin. A total body CT scan showed a mass in the left kidney that was subsequently removed. Histological features were consistent with a clear cell carcinoma. However, endoscopic examination of the digestive tract revealed an ulcerating and infiltrating adenocarcinoma of the gastric cardia. Total body PET/CT scan with 18F-FDG confirmed an isolated area of accumulation in the gastric cardia, with no hyperaccumulation at other sites. Conclusion To the best of our knowledge, there are no reports of pituitary metastases from gastric cardia adenocarcinoma. Our patient presented with symptoms of sellar involvement and without evidence of other body metastases. Therefore, sudden onset of diabetes insipidus and visual deterioration should lead to the suspicion of a rapidly growing pituitary mass, which may be the presenting manifestation of a primary extracranial adenocarcinoma. Histological investigation of the pituitary mass can guide the diagnostic workup, which must however be complete.
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Affiliation(s)
- Andrea Ghezzi
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jessica Rossi
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy,Neuromotor & Rehabilitation Department, Neurology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy,*Correspondence: Jessica Rossi,
| | - Francesco Cavallieri
- Neuromotor & Rehabilitation Department, Neurology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Service, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Service, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Romana Rizzi
- Neuromotor & Rehabilitation Department, Neurology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Marco Russo
- Neuromotor & Rehabilitation Department, Neurology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Gaetano Salomone
- Neuromotor & Rehabilitation Department, Neurology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Romano
- Neurosurgery Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Corrado Iaccarino
- Neurosurgery Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Froio
- Pathological Anatomy Service, Oncology Department and Advanced Technologies, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Serra
- Pathological Anatomy Service, Oncology Department and Advanced Technologies, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Salvatore Cozzi
- Radiation Oncology Unit, Oncological Department and Advanced Technologies, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Giaccherini
- Radiation Oncology Unit, Oncological Department and Advanced Technologies, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Franco Valzania
- Neuromotor & Rehabilitation Department, Neurology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Anna Pisanello
- Neuromotor & Rehabilitation Department, Neurology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
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Hong CS, Elsamadicy AA, Fisayo A, Inzucchi SE, Gopal PP, Vining EM, Erson-Omay EZ, Bulent Omay S. Comprehensive Genomic Characterization of A Case of Granular Cell Tumor of the Posterior Pituitary Gland: A Case Report. Front Endocrinol (Lausanne) 2021; 12:762095. [PMID: 34925233 PMCID: PMC8671743 DOI: 10.3389/fendo.2021.762095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Granular cell tumors of the pituitary belong to a rare family of neoplasms, arising from the posterior pituitary gland. Although considered benign, they may cause significant morbidity and residual disease after resection can lead to poor clinical outcomes. Currently, there is no known medical therapy for any posterior pituitary gland tumor, in part due to sparse molecular characterization of these lesions. We report data from whole exome sequencing of a case of granular cell tumor of the pituitary, performed under an institutional review board approved protocol. A 77 year-old female underwent resection of an incidentally diagnosed pituitary mass that was causing radiographic compression of the optic nerves with a subclinical temporal field defect and central hypothyroidism. The pathology of the resected specimen demonstrated a granular cell tumor of the posterior pituitary gland. Whole-exome sequencing revealed mutations predicted to be deleterious in key oncogenes, SETD2 and PAX8, both of which have been described in other cancers and could potentially be amenable to targeted therapies with existing approved drugs, including immune checkpoint inhibitors and histone deacetylase inhibitors, respectively. To our knowledge, this is the first comprehensive genomic characterization of granular cell tumor of the posterior pituitary gland. We report mutations in oncogenes predicted to be deleterious and reported in other cancers with potential for therapeutic targeting with existing pharmacologic agents. These data provide new insights into the molecular pathogenesis of GCT of the pituitary and may warrant further investigation.
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Affiliation(s)
- Christopher S. Hong
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, United States
| | | | - Adeniyi Fisayo
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, United States
| | - Silvio E. Inzucchi
- Section of Endocrinology, Department of Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Pallavi P. Gopal
- Department of Pathology, Yale School of Medicine, New Haven, CT, United States
| | - Eugenia M. Vining
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - E. Zeynep Erson-Omay
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, United States
- *Correspondence: E. Zeynep Erson-Omay, ; Sacit Bulent Omay,
| | - Sacit Bulent Omay
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, United States
- *Correspondence: E. Zeynep Erson-Omay, ; Sacit Bulent Omay,
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