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Huq S, Shanahan RM, Adida S, Bin-Alamer O, Abou-Al-Shaar H, Niranjan A, Hadjipanayis CG, Lunsford LD. Gamma knife radiosurgery for clival metastasis: case series and systematic review. J Neurooncol 2024; 168:171-183. [PMID: 38598088 DOI: 10.1007/s11060-024-04648-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Clival metastatic cancer is rare and has limited literature to guide management. We describe management of clival metastasis with Gamma Knife radiosurgery (GKRS). We augment our findings with a systematic review of all forms of radiation therapy for clival metastasis. METHODS Records of 14 patients with clival metastasis who underwent GKRS at the University of Pittsburgh Medical Center from 2002 to 2023 were reviewed. Treatment parameters and clinical outcomes were assessed. A systematic review was conducted using evidence-based guidelines. RESULTS The average age was 61 years with male predominance (n = 10) and average follow-up of 12.4 months. The most common primary cancers were prostate (n = 3) and lung (n = 3). The average time from cancer diagnosis to clival metastasis was 34 months. The most common presenting symptoms were headache (n = 9) and diplopia (n = 7). Five patients presented with abducens nerve palsies, and two presented with oculomotor nerve palsies. The median tumor volume was 9.3 cc, and the median margin dose was 15 Gy. Eleven patients achieved tumor control after one procedure, and three with progression obtained tumor control after repeat GKRS. One patient recovered abducens nerve function. The median survival from cancer diagnosis and GKRS were 49.7 and 15.3 months, respectively. The cause of death was progression of systemic cancer in six patients, clival metastasis in one, and unknown in four. The systematic review included 31 studies with heterogeneous descriptions of treatment and outcomes. CONCLUSION Clival metastasis is rare and associated with poor prognosis. GKRS is a safe, effective treatment for clival metastasis.
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Affiliation(s)
- Sakibul Huq
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA.
| | - Regan M Shanahan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA
| | - Samuel Adida
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA
| | - Othman Bin-Alamer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA
| | - Constantinos G Hadjipanayis
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA
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Wang H, Zhu M, Yan Y. Neuro-ophthalmological findings of pituitary metastasis: Case series from a single center and review of the literature. Heliyon 2024; 10:e26027. [PMID: 38379980 PMCID: PMC10877364 DOI: 10.1016/j.heliyon.2024.e26027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/10/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024] Open
Abstract
When pituitary metastasis (PM) invades the pituitary gland, it leads to impaired endocrine function and compression and infiltration of surrounding tissues, causing a series of clinical alterations. We presented seven patients with PM evaluated at neuro-ophthalmologic clinic and reviewed neuro-ophthalmological findings of 44 cases with PM in the English literature from 1979 to December 2022. The mean age at diagnosis was 58.1 years, and 45.1% were male. The mean latency period from primary cancer to the diagnosis of PM was 57.6 months. PM is the only presenting sign of malignancy in 11.8% of patients. The mean time from the visual disturbance to the diagnosis of PM was 96.3 days. Visual acuity decreased in 72.5% and 60.8% of cases with visual field defects. 74.2% exhibited a pattern of temporal field defect respecting the vertical meridian. Isolated ophthalmoplegia was found in 37.3% of patients. The most common ocular motor nerve palsy was unilateral III nerve palsy. Breast cancer was the most common primary malignancy. 84.6% entirely or partially relieved the neuro-ophthalmic symptoms after treatment. 51% of patients were alive during a mean follow-up period of 11 months. The mean survival duration was within six months in 65% of deceased patients. For elderly patients with a pituitary tumor, PM should be on the list of differential diagnoses for those with visual impairment, especially ocular motor nerve palsy, even if diabetic insipidus is not present, with or even without a history of malignancy, regardless of the primary tumor site.
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Affiliation(s)
- Hongliang Wang
- Department of Ophthalmology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Mingjie Zhu
- Department of Ophthalmology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Ottawa-Shanghai Joint School of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Yan
- Department of Ophthalmology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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One case of orbital apex syndrome caused by small cell lung cancer metastasis. Rev Neurol (Paris) 2021; 177:1032-1035. [PMID: 33810838 DOI: 10.1016/j.neurol.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 11/21/2022]
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Liu CY, Wang YB, Zhu HQ, You JL, Liu Z, Zhang XF. Hyperprolactinemia due to pituitary metastasis: A case report. World J Clin Cases 2021; 9:190-196. [PMID: 33511184 PMCID: PMC7809681 DOI: 10.12998/wjcc.v9.i1.190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/17/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pituitary metastasis is an uncommon manifestation of systemic malignant tumors. Moreover, hyperprolactinemia and overall hypopituitarism caused by metastatic spread leading to the initial symptoms are rare.
CASE SUMMARY A 53-year-old male patient was admitted to our hospital with complaints of bilateral blurred vision, dizziness, polyuria, nocturia, severe fatigue and somnolence, decreased libido, and intermittent nausea and vomiting for more than 6 mo. During the last 7 d, the dizziness had worsened. Laboratory investigations revealed overall hypofunction of the pituitary gland, but the patient had an elevated serum prolactin level (703.35 mg/mL). Preoperative magnetic resonance imaging revealed a tumor in the sellar region, accompanied by intratumoral hemorrhage and calcification. Thus, transnasal subtotal resection of the lesion in the sellar region was performed. The histopathological and immunohistochemical examinations of the resected lesion revealed metastasis of lung adenocarcinoma to the pituitary gland. Oral hydrocortisone (30 mg/d) and levothyroxine (25 mg/d) were given both pre- and postoperatively. Post-operatively, the clinical symptoms were significantly improved. However, 4 mo following the surgery, the patient succumbed due to multiple organ failure.
CONCLUSION Hyperprolactinemia is one of the markers of poor prognosis in patients with carcinoma that metastasizes to the pituitary gland. Exogenous hormone supplementation plays a positive role in relieving the symptoms of patients and improving quality of life.
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Affiliation(s)
- Chun-Yang Liu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yu-Bo Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Hui-Qin Zhu
- Department of Respiratory medicine, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Jin-Liang You
- Department of Neurosurgery, Linyi Cancer Hospital, Linyi 276000, Shandong Province, China
| | - Zhuang Liu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xian-Feng Zhang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Watanabe M, Yasuda J, Ashida K, Matsuo Y, Nagayama A, Goto Y, Iwata S, Watanabe M, Sasaki J, Hoshino T, Nomura M. Masked Diabetes Insipidus Hidden by Severe Hyponatremia: A Case of Pituitary Metastasis of Lung Adenocarcinoma. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e928113. [PMID: 33335085 PMCID: PMC7755591 DOI: 10.12659/ajcr.928113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Male, 70-year-old Final Diagnosis: Adrenal insufficiency • diabetes insipidus • lung adenocarcinoma Symptoms: Anorexia • fatigue Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic • Neurosurgery • Oncology
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Affiliation(s)
- Miki Watanabe
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Junichi Yasuda
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kenji Ashida
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yuko Matsuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Ayako Nagayama
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yuka Goto
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shimpei Iwata
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masayuki Watanabe
- Division of Respiratory, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Jun Sasaki
- Division of Respiratory, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tomoaki Hoshino
- Division of Respiratory, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masatoshi Nomura
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Division of Respiratory, Neurology, and Rheumatology, Department of Internal Medicine, Kurume, Fukuoka, Japan
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Benjamin C, Ashayeri K, Golfinos JG, Placantonakis DG, Silverman J, Kondziolka D. Treatment of sellar metastases with gamma knife radiosurgery in patients with advanced cancer. Pituitary 2020; 23:665-671. [PMID: 32860552 DOI: 10.1007/s11102-020-01074-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Metastases should be considered in a patient with a cancer history and a sellar/suprasellar lesion, as this diagnosis can change the management strategy in such patients. Once the diagnosis is established, stereotactic radiosurgery (SRS) can be a safe and effective approach for these patients. METHODS This case series describes five patients with pituitary metastases managed with GKRS at a single institution, taken from our prospective registry. All patients had SRS using the Gamma Knife Perfexion or Icon (Elekta), according to our standard institutional protocol. The optic nerves and chiasm were contoured, and the plan was adjusted to restrict dose to the optic apparatus as necessary. The tumor margin doses delivered were 11 Gy, 12 Gy, 14 Gy, 18 Gy (3 sessions of 6 Gy), and 12 Gy at the 50% isodose line. RESULTS In this series, all sellar metastases were treated successfully with good radiographic and clinical response. The histology of the tumors included endometrial, gastrointestinal, and lung adenocarcinomas. Typically, histology is taken into consideration when choosing the treatment dose, along with size and location. In these patients, however, the dose used for the sellar metastases was chosen primarily for visual safety. This was typically lower than the dose for brain metastases in other locations. CONCLUSION SRS provides an alternative treatment approach for sellar/suprasellar metastases with excellent local control, symptom improvement and maintenance of systemic therapy as desired. As such, CNS failure is rarely the proximate cause of demise in pituitary metastases provided that endocrinopathies are recognized and managed appropriately.
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Affiliation(s)
- Carolina Benjamin
- Department of Neurosurgery, University of Miami, Lois Pope Life Center, 1095 NE 14th Sreet 2nd Floor, Miami, FL, 33136, USA.
| | - Kimberly Ashayeri
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | | | - Joshua Silverman
- Department of Radiation Oncology, NYU Langone Medical Center, New York, NY, USA
| | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
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Alhashem A, Taha M, Almomen A. Pituitary metastasis of lung adenocarcinoma: Case report and literature review. Int J Surg Case Rep 2020; 67:98-101. [PMID: 32058309 PMCID: PMC7016037 DOI: 10.1016/j.ijscr.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 11/26/2022] Open
Abstract
Pituitary metastasis is rare, and it is the least common intracranial site of metastases. Majority of cases of pituitary metastasis the patient is known to have a primary malignancy. The clinical presentation and radiological features of pituitary metastasis are not specific making diagnosis difficult. Management may include endoscopic trans-sphenoidal resection, chemotherapy, radiotherapy and hormone replacement. Definitive diagnosis can be achieved through surgical resection.
Introduction Pituitary metastasis is rare, and it is the least common site of intracranial metastases. It is mostly asymptomatic but can present with diabetes insipidus, headache, ophthalmoplegia, visual disturbance and anterior pituitary dysfunction and in majority of cases patients known to have a primary malignancy. Case Presentation This study presents a 54-year-old male presented with a few months history of headache and drooping of both eyelids and after proper investigations and endoscopic resection of the sellar mass the diagnosis was confirmed to be pituitary metastasis of lung adenocarcinoma. Conclusion Diagnosis and management of pituitary metastases are complex and depend on many factors. Endoscopic surgical resection and debulking alleviates symptoms and provides the definitive diagnosis which has great importance in cases with clinical presentation that does not strongly point to pituitary metastasis to avoid unnecessary radiotherapy and chemotherapy when possible.
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Affiliation(s)
| | - Mahmoud Taha
- Department of Neurosurgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ali Almomen
- Department of Otorhinolaryngology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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