[Intrapituitary adenoma metastasis from lung cancer with progressive cranial nerve palsies: a case report and literature review]

Pituitary Metastatic Composite Tumors: A Case Report with Next-Generation Sequencing and Review of the Literature

Background

While pituitary tumors are well understood, little research has been done on metastasis from primary tumors into pituitary adenomas, also known as composite tumors. Because only 34 cases of composite tumors have been reported to date, we hope to better characterize these tumors by reviewing cases reported in the literature and reviewed our own documented case, which includes next-generation sequencing. Case Presentation. A 74-year-old man presented to the emergency department with left vision loss for 3 months. He had a history of colon cancer treated with colectomy and clear cell renal carcinoma treated with left nephrectomy. A preoperative MRI demonstrated growth of a peripherally enhancing, centrally necrotic mass with sellar expansion measuring 5.7 × 3.1 × 3.0 cm. Given these findings, an endoscopic endonasal transsphenoidal resection was performed. Histological assessment revealed a composite tumor: one neoplasm was a nonfunctioning pituitary adenoma, and another neoplasm was a clear cell carcinoma. Next-generation sequencing demonstrated that the tumors shared mutations in VHL and Notch2. The patient died 2 months later from systemic metastatic cancer.

Conclusion

From our literature review, most metastatic lesions in these composite tumors originated from neoplasms of the lung and kidney. Approximately 63% patients presented with ophthalmoplegia as the initial symptom while 23% displayed hormonal abnormalities. Postoperative mortality had a median of 3.5 months. In our patient, the presence of VHL and Notch2 mutations in both tumors highlights the possibility of using next-generation sequencing to help identify therapeutic targets even in complex composite neoplasms.

Progressive visual disturbance and enlarging prolactinoma caused by melanoma metastasis: A case report and literature review

RATIONALE

Melanoma metastases to the pituitary adenoma (MMPA) are extremely rare, with only 1 reported case. To date, the melanoma metastasis to the existing prolactinoma has not been reported in literatures.

PATIENT CONCERNS

We report a case of 62-year-old woman presented with progressive visual disturbance and hyperprolactinemia. Magnetic resonance imaging demonstrated the presence of a round sellar mass.

DIAGNOSES

Melanoma metastasis to the pituitary adenoma.

INTERVENTIONS

Surgery was performed and intraoperative frozensection examination found melanin granules and histopathological examination confirmed melanoma metastasis to the pituitary adenoma.

OUTCOMES

After surgery, the patient developed widespread melanoma metastasis to lower limbs. Twenty-two months later, the patient was alive with worse symptoms.

LESSONS

We reviewed and analyzed the clinical data, imaging features, and treatment methods of other reported cases of metastases to pituitary adenoma (MPA). This study provides clinical information for the diagnosis and management of MMPA.