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Mazar‐Atabaki A, Mohamadzadeh O, Sadrehosseini SM, Tabari A, Zeinalizadeh M. Pituitary metastasis from renal cell carcinoma presenting with significant hyperprolactinemia, case report. Clin Case Rep 2023; 11:e7808. [PMID: 37636878 PMCID: PMC10457481 DOI: 10.1002/ccr3.7808] [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: 01/29/2023] [Revised: 05/09/2023] [Accepted: 06/19/2023] [Indexed: 08/29/2023] Open
Abstract
Key Clinical Message Kidney metastasis to the pituitary gland can cause hyperprolactinemia even above 250 ng/mL. Although the treatment of metastasis is palliative, surgical decompression could play a major role in the recovery of symptoms and improve quality of life. Pituitary metastasis should be considered in the evaluation of an unusual pituitary mass. Abstract Pituitary tumors are frequently encountered in the neurosurgical setting. Although the majority of them are pituitary adenomas, rare entities encompass pituitary metastasis. They should be differentiated from pituitary adenomas because their management and prognosis are different. We report a 53-year-old female who complained of headache and had remarkable hyperprolactinemia (271.1 ng/mL). Having considered macroprolactinoma as the initial diagnosis, medical treatment was initiated with Cabergoline. Subsequently, the patient's vision deteriorated which prompted us to perform endoscopic endonasal transsphenoidal surgery. Histologic examination of the resected tumor revealed metastatic renal cell carcinoma. Main treatment for these subjects is palliative; and unlike the pituitary adenoma, the prognosis is unfortunately poor. Pituitary metastasis should be considered in the evaluation of an unusual pituitary mass associated with hyperprolactinemia.
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Affiliation(s)
- Ali Mazar‐Atabaki
- Brain and Spinal Injury Research Center, Pituitary ClinicImam Khomeini Hospital Complex, Tehran University of Medical SciencesTehranIran
- Department of Neurological Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Omid Mohamadzadeh
- Brain and Spinal Injury Research Center, Pituitary ClinicImam Khomeini Hospital Complex, Tehran University of Medical SciencesTehranIran
- Department of Neurological Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Seyed Mousa Sadrehosseini
- Department of Otolaryngology‐Head and Neck Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Azin Tabari
- Department of Otolaryngology‐Head and Neck Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Mehdi Zeinalizadeh
- Department of Neurological Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
- Brain and Spinal Injury Research Center, Pituitary ClinicNeuroscience Institute, Tehran University of Medical SciencesTehranIran
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Azab WA, Khan T, Alqunaee M, Al Bader A, Yousef W. Endoscopic Endonasal Surgery for Uncommon Pathologies of the Sellar and Parasellar Regions. Adv Tech Stand Neurosurg 2023; 48:139-205. [PMID: 37770685 DOI: 10.1007/978-3-031-36785-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Endoscopic skull base surgery has become an integral part of the present neurosurgical armamentarium. The pioneering efforts in which the purely endoscopic transsphenoidal approach was introduced have triggered a growing tide of using the endoscopic endonasal procedures for a large variety of skull base lesions. Because of their anatomical peculiarities, lesions of the sellar and parasellar regions lend themselves very well to the endoscopic endonasal approaches. Apart from the common pathological entities, many other less frequent pathologies are encountered in the sellar and parasellar area. In this chapter, we review the surgical technique of the endoscopic endonasal transsphenoidal approach and its extensions applied to a variety of rare and uncommon pathological entities involving the sella turcica and clivus. An overview of these pathological entities is also presented and exemplified.
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Affiliation(s)
- Waleed A Azab
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Tufail Khan
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Marwan Alqunaee
- Rhinology - Endoscopic Sinus and Skull Base Surgery, Zain Hospital, Kuwait City, Kuwait
| | - Abdullah Al Bader
- Rhinology - Endoscopic Sinus and Skull Base Surgery, Jaber Al Ahmad Hospital, Kuwait City, Kuwait
| | - Waleed Yousef
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
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3
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Öven BB, Demir MK, Çelik S, Moujawaz R, Somay A, Kılıc T. Isolated Pituitary Metastasis of Renal Cell Carcinoma: A Case Report and Systematic Review of the Literature. Curr Med Imaging 2022; 18:1426-1432. [PMID: 35490330 DOI: 10.2174/0929866529666220426121245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Isolated pituitary gland metastasis is an extremely rare event in renal cell carcinoma. We present a unique case of isolated pituitary metastasis of renal cell carcinoma and a systematic review of literature on it. CASE REPORT In this case, an abdominal ultrasound in an asymptomatic 51-year-old female patient showed a mass in her left kidney. Radical nephrectomy was performed and the tumor was diagnosed as a stage 1 clear cell carcinoma. Throughout the 3 months of the follow-up period, the patient started complaining of visual disturbances and headaches. A pituitary mass was found on brain magnetic resonance imaging and was suspected to be a macroadenoma. Surgical resection of the tumor was performed and the final pathological diagnosis was made as a pituitary metastasis of the renal cell carcinoma. After surgery, radiotherapy with sunitinib, a receptor tyrosine inhibitor, was performed. CONCLUSION The clinical symptoms are usually related to the mass effect of the tumor and anterior pituitary involvement. Most of the cases mimic pituitary macroadenoma on MRI. The most preferred treatment combination is surgery and radiotherapy. We recommend adding sunitinib to this combination. This illustrative case and those found in a systematic review of the literature highlight the importance of histopathologic diagnosis and appropriate management since isolated pituitary metastasis is challenging to preoperative diagnosis.
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Affiliation(s)
- Bala Başak Öven
- Department of Oncology, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, Istanbul, Turkey
| | - Mustafa Kemal Demir
- Department of Radiology, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, Istanbul, Turkey
| | - Serkan Çelik
- Department of Oncology, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, Istanbul, Turkey
| | - Riad Moujawaz
- Medical Student, Bahçeşehir University School of Medicine, Istanbul, Turkey
| | - Adnan Somay
- Department of Pathology, Fatih Sultan Mehmet Training and Education Hospital, Istanbul, Turkey
| | - Turker Kılıc
- Department of Neurosurgery, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, Istanbul, Turkey
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4
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Hashimoto H, Maruo T, Nakamura M, Ushio Y, Hirata M, Kishima H. Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report. J Med Case Rep 2022; 16:12. [PMID: 35027091 PMCID: PMC8759158 DOI: 10.1186/s13256-021-03229-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 12/14/2021] [Indexed: 02/07/2023] Open
Abstract
Background Symptomatic pituitary metastasis is rare; furthermore, it can result in diabetes insipidus and panhypopituitarism. Since diabetes insipidus is masked by concurrent panhypopituitarism, it can impede the diagnosis of pituitary dysfunction. Case presentation A 68-year-old Japanese female suffering from pituitary and thalamic metastases caused by untreated breast cancer, underwent a biopsy targeting the thalamus, not the pituitary. She lacked prebiopsy pituitary dysfunction symptoms; however, these symptoms unexpectedly occurred after biopsy. Diabetes insipidus was masked by corticosteroid insufficiency, and she showed normal urinary output and plasma sodium levels. Upon commencement of glucocorticoid replacement therapy, the symptoms of diabetes insipidus appeared. Conclusions In this case, thalamic biopsy, as opposed to pituitary biopsy, was performed to preserve pituitary function. However, pituitary dysfunction could not be avoided. Caution is necessary for asymptomatic patients with pituitary metastases as invasive interventions, such as surgery, may induce pituitary dysfunction. Moreover, with respect to masked diabetes insipidus, there is a need to carefully consider pituitary dysfunction to avoid misdiagnosis and delayed treatment.
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Affiliation(s)
- Hiroaki Hashimoto
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540-0008, Japan. .,Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan.
| | - Tomoyuki Maruo
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540-0008, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Masami Nakamura
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540-0008, Japan
| | - Yukitaka Ushio
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540-0008, Japan
| | - Masayuki Hirata
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
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5
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Dai C, Liang S, Sun B, Li Y, Kang J. Anti-VEGF Therapy in Refractory Pituitary Adenomas and Pituitary Carcinomas: A Review. Front Oncol 2021; 11:773905. [PMID: 34869016 PMCID: PMC8635636 DOI: 10.3389/fonc.2021.773905] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/27/2021] [Indexed: 12/24/2022] Open
Abstract
Most pituitary tumors are considered benign adenomas, and only 0.1%–0.2% of them present metastasis and are defined as pituitary carcinomas (PCs). Refractory pituitary adenomas (PAs) lie between benign adenomas and true malignant PCs and are defined as aggressive-invasive PAs, characterized by a high Ki-67 index, rapid growth, frequent recurrence, and resistance to conventional treatments. Refractory PAs and PCs are notoriously difficult to manage because of limited therapeutic options. Vascular endothelial growth factor (VEGF) plays a crucial role in angiogenesis not only during development but also during pathological processes in pituitary tumors. Recently, increasing numbers of preclinical studies and clinical research have demonstrated that anti-VEGF therapy plays an important role in pituitary tumors. The purpose of this review is to report the role of VEGF in the development and pathology of pituitary tumors and the progress of anti-VEGF therapy in pituitary tumors, including refractory PAs and PCs. Previous preclinical studies indicated that cyclin-dependent kinase 5 (CDK5)-mediated VEGF expression might play a crucial role in the development of PAs. Vascular endothelial growth inhibitors have been reported as independent predictors of invasion in human PAs and have been indicated as markers for poor outcome. Furthermore, several studies have reported that angiogenesis decreases tumor sizes in experimental animal models of pituitary tumors. The expression of VEGF is relatively high in PAs; therefore, anti-VEGF therapy has been used in some refractory PAs and PCs. To date, anti-VEGF has been reported as monotherapy, in combination with temozolomide (TMZ), TMZ and radiotherapy, and with pasireotide, which might be a promising alternative therapy for refractory PAs and PCs resistant to conventional treatments. However, the role of anti-VEGF therapy in pituitary tumors is still controversial due to a lack of large-scale clinical trials. In summary, the results from preclinical studies and clinical trials indicated that anti-VEGF therapy monotherapy or in combination with other treatments may be a promising alternative therapy for refractory PAs and PCs resistant to conventional treatments. More preclinical studies and clinical trials are needed to further evaluate the exact efficacy of anti-VEGF in refractory PAs and PCs.
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Affiliation(s)
- Congxin Dai
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Siyu Liang
- Eight-Year Program of Clinical Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Bowen Sun
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yong Li
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jun Kang
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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6
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Moon RDC, Singleton WGB, Smith P, Urankar K, Evans A, Williams AP. Slow-Growing Pituitary Metastasis from Renal Cell Carcinoma: Literature Review. World Neurosurg 2020; 145:416-425. [PMID: 32891842 DOI: 10.1016/j.wneu.2020.08.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Tumor metastasis to the pituitary is rare, most commonly reported with either breast or lung cancer metastasizing to the neurohypophysis. Pituitary metastases of renal cell carcinoma (RCC) are by contrast infrequently described even within this scarce literature. We present an illustrative case of RCC pituitary metastasis 15 years after radical nephrectomy for primary disease and a review of the published literature. CASE DESCRIPTION A 69-year-old female was diagnosed with a large sellar mass with suprasellar extension. The initial radiologic diagnosis was most in keeping with pituitary macroadenoma, although prominent vascular flow voids were noted. Endoscopic endonasal transsphenoidal adenectomy was challenging on account of significant intraoperative hemorrhage from an unusually vascular tumor. Pathologic examination supported a diagnosis of metastatic clear cell renal carcinoma. Literature review identified 41 cases of RCC pituitary metastasis since 1984. The mean age at time of diagnosis with pituitary metastasis was 59.5 years (range 35-81 years, 73% male). Pituitary metastasis was the initial presentation of RCC in 10 patients. The median time from RCC diagnosis to pituitary metastasis was 1 year (range 0-27 years). Surgical resection was performed for 30 patients, of which 47% reported a highly vascular tumor. CONCLUSIONS We highlight the potential for delayed metastasis to the pituitary to masquerade as a macroadenoma. Imaging consistent with rich vascularity should bring the diagnosis of RCC metastasis into the differential and is important to note when planning surgical resection in such cases.
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Affiliation(s)
- Richard D C Moon
- Department of Neurosurgery, North Bristol NHS Trust, Bristol, UK.
| | | | - Paul Smith
- Department of Neuroradiology, North Bristol NHS Trust, Bristol, UK
| | - Kathryn Urankar
- Department of Neuropathology, North Bristol NHS Trust, Bristol, UK
| | - Alison Evans
- Department of Endocrinology and Metabolic Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Adam P Williams
- Department of Neurosurgery, North Bristol NHS Trust, Bristol, UK
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7
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Gandhi GY, Fung R, Natter PE, Makary R, Balaji KC. Symptomatic Pituitary Metastasis as Initial Manifestation of Renal Cell Carcinoma: Case Report and Review of Literature. Case Rep Endocrinol 2020; 2020:8883864. [PMID: 32908722 PMCID: PMC7450332 DOI: 10.1155/2020/8883864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 02/07/2023] Open
Abstract
Metastasis to the pituitary gland is extremely rare (∼2% of sellar masses). Clinical, biochemical, and radiologic characteristics of pituitary metastasis are poorly defined and can be difficult to diagnose before surgery. We present an unusual case with pituitary metastasis as the first manifestation of renal cell carcinoma (RCC). A 70-year-old male presented with acute onset of weakness, dizziness, diplopia, and progressively worsening headache. The initial CT head revealed a heterogeneous sellar mass measuring 2.8 × 1.9 × 1.7 cm. A follow-up MRI showed the sellar mass invading the right cavernous sinus. The presumptive diagnosis was a pituitary macroadenoma. Physical examination revealed bilateral 6th cranial nerve palsy and episodes of intermittent binocular horizontal diplopia. Hormonal testing noted possible secondary adrenal insufficiency (AM serum cortisol: 3.3 mcg/dL, ACTH: 8 pg/mL), secondary hypothyroidism (TSH: <0.01 mIU/L, FT4: 0.7 ng/dL), secondary hypogonadism (testosterone: 47 ng/dL, LH: 1.3 mIU/mL, and FSH: 2.3 mIU/mL), and elevated serum prolactin (prolactin: 56.8 ng/ml, normal: 4.0-15.2 ng/ml). IGF-1 level was normal at 110 ng/mL (47-192 ng/mL). The patient was discharged on levothyroxine and hydrocortisone therapy with plans for close surveillance. However, his condition worsened over the next three months, and he was subsequently readmitted with nausea, vomiting, and hypernatremia secondary to diabetes insipidus. Repeat MRI pituitary showed an interval increase in the size of the sellar mass with suprasellar extension and a new mass effect on the optic chiasm. The sellar mass was urgently resected via a trans-sphenoidal approach. The tumor was negative for neuroendocrine markers and pituitary hormone panel, ruling out the diagnosis of pituitary adenoma and triggered workup for metastatic renal cell carcinoma, clear cell type. The diagnosis of renal cell carcinoma was confirmed by the diffuse and strong staining for renal cell carcinoma markers (Pax-8, RCC-1, and CD10). A follow-up CT scan noted large right renal mass measuring 11 × 10 × 11 cm. The patient underwent a cytoreductive robotic right radical nephrectomy for WHO/ISUP histologic grade II clear cell RCC, stage pT2b pNX pM1. He subsequently received fractionated stereotactic radiotherapy to the pituitary gland. He is presently stable with no radiological evidence of progression or new intracranial disease on subsequent imaging. Pituitary metastasis most commonly occurs from breast, lung, or gastrointestinal tumors but also rarely from renal cell carcinoma. Biochemical findings such as panhypopituitarism, acute clinical signs such as headache, visual symptoms, and diabetes insipidus and interval increase in sellar mass in a short time interval should raise suspicion for sellar metastasis.
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Affiliation(s)
- Gunjan Y. Gandhi
- Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Russell Fung
- Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Patrick E. Natter
- Department of Radiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Raafat Makary
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - K. C. Balaji
- Department of Urology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
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8
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Ohashi Y, Tsunoda N, Onodera K, Iijima S, Miyamoto I, Chiba T, Yamada H. Hypopituitarism manifesting after invasive dental treatment in a patient with carcinoma of the tongue: a case report. BMC Oral Health 2020; 20:106. [PMID: 32293413 PMCID: PMC7160967 DOI: 10.1186/s12903-020-01082-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 03/19/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The symptoms of hypopituitarism are not usually discussed in the clinical setting of oral surgery. CASE PRESENTATION We herein report a case of hypopituitarism that became evident after biopsy and extraction of several teeth in a 68-year-old man with tongue cancer. Three days after biopsy, the patient developed nausea and vomiting, and his serum sodium had fallen to 124 mEq/L. His serum cortisol concentration was low. Although the plasma concentration of adrenocorticotropic hormone (ACTH) was within the normal range, ACTH stimulation testing showed a lack of cortisol response. Given these findings, we suspected secondary adrenal insufficiency. To investigate the cause of secondary adrenal insufficiency, MRI of the head was performed, which revealed pituitary gland atrophy. The results of pituitary anterior lobe hormone-stimulation tests were compatible with hypopituitarism. Thirty days after biopsy, partial tongue resection was successfully performed under general anesthesia with perioperative hydrocortisone supplementation. CONCLUSIONS We must be aware of various signs of hypopituitarism when we perform invasive dental treatment.
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Affiliation(s)
- Yu Ohashi
- grid.411790.a0000 0000 9613 6383Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University School of Dentistry, 19-1, Uchimaru, Morioka, Iwate 020- 8505 Japan
| | - Naoko Tsunoda
- grid.411790.a0000 0000 9613 6383Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University School of Dentistry, 19-1, Uchimaru, Morioka, Iwate 020- 8505 Japan
| | - Kei Onodera
- grid.411790.a0000 0000 9613 6383Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University School of Dentistry, 19-1, Uchimaru, Morioka, Iwate 020- 8505 Japan
| | - Shin Iijima
- grid.411790.a0000 0000 9613 6383Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University School of Dentistry, 19-1, Uchimaru, Morioka, Iwate 020- 8505 Japan
| | - Ikuya Miyamoto
- grid.411790.a0000 0000 9613 6383Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University School of Dentistry, 19-1, Uchimaru, Morioka, Iwate 020- 8505 Japan
| | - Toshimi Chiba
- grid.411790.a0000 0000 9613 6383Division of Internal Medicine of Dentistry, Department of Oral medicine, Iwate Medical University School of Dentistry, 19-1, Uchimaru, Morioka, 020-8505 Japan
| | - Hiroyuki Yamada
- grid.411790.a0000 0000 9613 6383Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University School of Dentistry, 19-1, Uchimaru, Morioka, Iwate 020- 8505 Japan
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9
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Li B, Cheng JH, Zhu HB, Li CZ, Zhang YZ, Zhao P. Pituitary metastasis from renal cell carcinoma: case report and review of the literature. Int J Neurosci 2020; 131:199-205. [PMID: 32098537 DOI: 10.1080/00207454.2020.1734599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pituitary metastasis(PM) from renal cell carcinoma(RCC) is rare, and is easy to be misdiagnosed. Here, we present a case of pituitary metastasis from clear-cell renal cell carcinoma(ccRCC) which was difficult to distinguish from other sellar region tumors. In addition, we systematically review the literature to find the characteristics of different tumors of the sellar region. It provides a new idea for the diagnosis of sellar region tumors in the clinic.
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Affiliation(s)
- Bin Li
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Hua Cheng
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hai-Bo Zhu
- Department of Cell and Biology, Beijing Neurosurgical Institute, Beijing, China
| | - Chu-Zhong Li
- Department of Cell and Biology, Beijing Neurosurgical Institute, Beijing, China
| | - Ya-Zhuo Zhang
- Department of Cell and Biology, Beijing Neurosurgical Institute, Beijing, China
| | - Peng Zhao
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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10
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Current status and treatment modalities in metastases to the pituitary: a systematic review. J Neurooncol 2020; 146:219-227. [PMID: 31933258 DOI: 10.1007/s11060-020-03396-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Metastases to the pituitary (MP) are uncommon, accounting for 0.4% of intracranial metastases. Through advances in neuroimaging and oncological therapies, patients with metastatic cancers are living longer and MP may be more frequent. This review aimed to investigate clinical and oncological features, treatment modalities and their effect on survival. METHODS A systematic review was performed according to PRISMA recommendations. All cases of MP were included, excepted primary pituitary neoplasms and autopsy reports. Descriptive and survival analyses were then conducted. RESULTS The search identified 2143 records, of which 157 were included. A total of 657 cases of MP were reported, including 334 females (50.8%). The mean ± standard deviation age was 59.1 ± 11.9 years. Lung cancer was the most frequent primary site (31.0%), followed by breast (26.2%) and kidney cancers (8.1%). Median survival from MP diagnosis was 14 months. Overall survival was significantly different between lung, breast and kidney cancers (P < .0001). Survival was impacted by radiotherapy (hazard ratio (HR) 0.49; 95% confidence interval (CI) 0.35-0.67; P < .0001) and chemotherapy (HR 0.58; 95% CI 0.36-0.92; P = .013) but not by surgery. Stereotactic radiotherapy tended to improve survival over conventional radiotherapy (HR 0.66; 95% CI 0.39-1.12; P = .065). Patients from recent studies (≥ 2010) had longer survival than others (HR 1.36; 95% CI 1.05-1.76; P = .0019). CONCLUSION This systematic review based on 657 cases helped to better identify clinical features, oncological characteristics and the effect of current therapies in patients with MP. Survival patterns were conditioned upon primary cancer histologies, the use of local radiotherapy and systemic chemotherapy, but not by surgery.
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11
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Khorsand-Rahimzadeh A, Khatami F, Sefidbakht S, Saffar H, Tavangar SM. Dyspnea as the First Manifestation of Silent Renal Cell Carcinoma. IRANIAN JOURNAL OF PATHOLOGY 2019; 14:87-93. [PMID: 31531106 PMCID: PMC6708564 DOI: 10.30699/ijp.14.1.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 12/24/2018] [Indexed: 11/29/2022]
Abstract
Renal cell carcinoma (RCC) accounts for only 3% of adult malignancies, and the lung is the most common site of metastasis of this tumor, which may be accompanied by pleural metastasis. However, solitary pleural involvement is very rare and its presentation with dyspnea as the first manifestation of RCC is extremely rare. We describe a 39-year-old male with episodes of dyspnea dating back 6 months prior to hospital admission. During paraclinical investigations, chest computed tomography (CT) demonstrated pleural effusion and multiple pulmonary nodules, raising the question of primary mesothelioma or metastasis from distant focus. Histopathology and immuno- histochemical examinations of pleural biopsy provided evidence of metastatic RCC of the clear cell type. Therefore, an abdominal contrast computed tomography (CT) was performed, revealing a 3 cm right renal mass, which was then removed by partial nephrectomy. Physicians and pathologists should be aware of unusual presentations of RCC with no symptoms attributable to the kidneys, including dyspnea as in our case.
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Affiliation(s)
| | - Fatemeh Khatami
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Salma Sefidbakht
- Dept. of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hiva Saffar
- Dept. of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Tavangar
- Dept. of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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12
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Mekki A, Dercle L, Lichtenstein P, Nasser G, Marabelle A, Champiat S, Chouzenoux E, Balleyguier C, Ammari S. Machine learning defined diagnostic criteria for differentiating pituitary metastasis from autoimmune hypophysitis in patients undergoing immune checkpoint blockade therapy. Eur J Cancer 2019; 119:44-56. [PMID: 31415986 DOI: 10.1016/j.ejca.2019.06.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/09/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE New-onset pituitary gland lesions are observed in up to 18% of cancer patients undergoing treatment with immune checkpoint blockers (ICB). We aimed to develop and validate an imaging-based decision-making algorithm for use by the clinician that helps differentiate pituitary metastasis (PM) from ICB-induced autoimmune hypophysitis (HP). MATERIALS AND METHODS A systematic search was performed in the MEDLINE and EMBASE databases up to October 2018 to identify studies concerning PM and HP in patients treated with cytotoxic T-lymphocyte-associated protein 4 and programmed cell death (ligand) 1. The reference standard for diagnosis was confirmation by histology or response on follow-up imaging. Patients from included studies were randomly assigned to the training set or the validation set. Using machine learning (random forest tree algorithm) with the most-described six imaging and three clinical features, a multivariable prediction model (the signature) was developed and validated for diagnosing PM. Signature performance was evaluated using area under a receiver operating characteristic curves (AUCs). RESULTS Out of 3174 screened articles, 65 were included totalising 122 patients (HP: 60 pts, PM: 62 pts). Complete radiological data were available in 82 pts (Training: 62 pts, Validation: 20 pts). The signature reached an AUC = 0.91 (0.82, 1.00), P < 10-8 in the training set and AUC = 0.94 (0.80, 1.00), P = 0.001 in the validation set. The signature predicted PM in lesions either ≥ 2 cm in size or < 2 cm if associated with heterogeneous contrast enhancement and cavernous extension. CONCLUSION An image-based signature was developed with machine learning and validated for differentiating PM from HP. This tool could be used by clinicians for enhanced decision-making in cancer patients undergoing ICB treatment with new-onset, concerning lesions of the pituitary gland.
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Affiliation(s)
- Ahmed Mekki
- Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris-Saclay, Paris, France; Department of Neuroradiology, C.H.U Bicêtre AP-HP, Le Kremlin-Bicêtre, France.
| | - Laurent Dercle
- Université Paris-Saclay, Paris, France; Gustave Roussy, Université Paris-Saclay, Institut National de La Santé et de La Recherche Médicale (INSERM), U1015, Equipe Labellisée Ligue Nationale Contre le Cancer, Villejuif, F-94805, France; Department of Radiology, Columbia University Medical Center, NYC, NY, USA.
| | | | - Ghaida Nasser
- Department of Neuroradiology, C.H.U Bicêtre AP-HP, Le Kremlin-Bicêtre, France
| | | | | | - Emilie Chouzenoux
- Center for Visual Computing, CentraleSupelec, INRIA Saclay, Gif-sur-Yvette, 91190, France
| | - Corinne Balleyguier
- Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris-Saclay, Paris, France
| | - Samy Ammari
- Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris-Saclay, Paris, France
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13
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Clinical management of a pituitary gland metastasis from clear cell renal cell carcinoma. Anticancer Drugs 2019; 29:710-715. [PMID: 29846249 DOI: 10.1097/cad.0000000000000644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In very few years, several treatments have significantly improved the prognosis of patients with metastatic renal cell carcinoma (RCC). Despite this, the clinical outcomes of specific subgroups of patients including those with central nervous metastases still remain poor. In this population, a very infrequent and poorly described site of metastases is the pituitary gland. Because of the important endocrinal function and the anatomic site of this specific organ, clinical management of this complication requires several additional precautions compared with other central nervous metastases. Here, we describe a case of a single pituitary metastasis from clear cell RCC in a patient who showed a surprising progression-free survival and overall survival to sunitinib first-line treatment. Because of the uncommon clinical course of the disease of our patient and the atypical site of metastases, we want also to underline the importance of further investigation of molecular pathways associated with a favorable prognosis in patients with metastatic clear cell RCC.
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14
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Cai H, Liu W, Feng T, Li Z, Liu Y. Clinical Presentation and Pathologic Characteristics of Pituitary Metastasis from Breast Carcinoma: Cases and a Systematic Review of the Literature. World Neurosurg 2019; 124:445-451.e2. [PMID: 30630045 DOI: 10.1016/j.wneu.2018.12.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is rare for breast carcinoma to metastasize to the pituitary gland; this finding indicates extensive metastasis of the primary tumor. CASE DESCRIPTION Herein, we present a 57-year-old patient with pituitary gland metastasis from breast cancer that was treated with extensive radical mastectomy 16 years prior. The pituitary was the sole site of metastasis. The patient was admitted with the chief complaint of blurred vision for 1 year and episodic headaches for 1 month. Magnetic resonance imaging revealed a solid mass in the sellar region with heterogenous contrast enhancement. The preoperative diagnosis was a pituitary adenoma. Neuroendoscopy-assisted tumor resection was conducted through a single-nostril sphenoid sinus approach. A pinkish-white, firm neoplasm was found, with an abundant blood supply and an indistinct boundary between the neoplasm and normal pituitary tissue; complete resection was achieved. The results of immunohistochemical analysis were positive for cytokeratin, Ki-67antigen, estrogen receptors, progesterone receptors, and prolactin-induced protein. The neoplasm was negative for spalt-like transcription factor 4, mammaglobin, and the alpha subunit of the glycoprotein hormones. These results were used to reach a final diagnosis of pituitary gland metastasis from a primary breast carcinoma. The patient's vision improved significantly after surgery, and no recurrence was detected during 1 year of follow-up. CONCLUSIONS Pituitary gland metastasis is rare and difficult to differentiate from a pituitary adenoma without a pathologic diagnosis. Surgery is the first choice for treatment. Surgery, radiotherapy, and chemotherapy are combined with endocrine therapy to tailor treatment to the results of immunohistochemistry.
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Affiliation(s)
- Heng Cai
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wenjing Liu
- Department of Geriatrics, First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Tianda Feng
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Zhen Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yunhui Liu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
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Abstract
RATIONALE Sellar metastasis is a rare and complex disease whose clinical features are strongly associated with the primary malignancy. Here, we present a rare case of giant sellar metastasis spread from renal cell carcinoma (RCC). PATIENT CONCERNS A 30-year-old Chinese woman was admitted to our Hospital, reporting headache, nasal congestion, nausea, vomiting, and a sharp decline in her right eye vision. DIAGNOSES Brain magnetic resonance imaging (MRI) revealed an invasive sellar mass with cavernous sinus and nasal cavity extension. Additionally, the patient had a medical history of right radical nephrectomy for clear-cell RCC. INTERVENTIONS The patient underwent a successful subtotal resection of the tumor. Final pathological diagnosis confirmed sellar metastasis from RCC. After surgery, the patient was referred to our medical oncology department and received further systemic therapy. OUTCOMES No light perception remained in her right eye even after prompt surgical decompression. Follow-up MRI showed subtotal resection of the giant sellar metastasis. LESSON Sellar metastasis, although rare, should be particularly considered for elderly patients with deteriorating visual function and medical histories of cancer.
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16
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Javanbakht A, D'Apuzzo M, Badie B, Salehian B. Pituitary metastasis: a rare condition. Endocr Connect 2018; 7:EC-18-0338. [PMID: 30139817 PMCID: PMC6198191 DOI: 10.1530/ec-18-0338] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/20/2018] [Indexed: 01/31/2023]
Abstract
Tumor metastasis to the pituitary gland is a life-threatening condition associated with short life span. Pituitary metastasis is rare, however, and not well-documented. A better understanding of its clinical manifestations could lead to earlier diagnosis, appropriate therapy, and potentially improving quality of life. Therefore, we retrospectively studied the charts of patients with pituitary metastases who were treated at the City of Hope National Medical Center in Duarte, California, from 1984 to 2018. We reviewed and analyzed tumor origin, primary pituitary clinical manifestation, duration between primary tumor diagnosis and pituitary metastasis, type of treatment, and patient survival. A total 11 patients with a mean age of 59.2 years and median survival of 50.33 months were identified. Breast cancer and lymphoma were the most common primary origins in these cases, and diabetes insipidus and panhypopituitarism were the most common primary manifestations of their metastasis. We also compared our results with reports in the literature published between 1957 and 2018. A total 289 patients with pituitary metastasis have been reported in the literature. Breast cancer was the most frequent primary origin of the metastasis, and visual involvement was the most common primary manifestation. The posterior part of the pituitary is more susceptible than the anterior to metastasis. Pituitary metastasis may occur as a consequence of successful primary tumor treatment prolonging the chance of seeding. Future studies are needed to determine the molecular mechanism of metastasis to the pituitary.
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Affiliation(s)
- Aida Javanbakht
- A Javanbakht, Department of Diabetes, Endocrinology and Metabolism, Beckman Research Institute, Duarte, United States
| | - Massimo D'Apuzzo
- M D'Apuzzo, Department of Pathology, Beckman Research Institute, Duarte, United States
| | - Behnam Badie
- B Badie, Department of Neurosurgery, Beckman Research Institute, Duarte, United States
| | - Behrouz Salehian
- B Salehian, Endocrinology, City of Hope National Medical Center, Duarte, 91010, United States
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17
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Souza Mota J, de Sá Caldas A, de Araújo Cortês Nascimento AGP, Dos Santos Faria M, Pereira Sobral CS. Pituitary Metastasis of Thyroid Carcinoma: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:896-902. [PMID: 30061553 PMCID: PMC6080086 DOI: 10.12659/ajcr.909523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pituitary metastasis of thyroid carcinoma is a rare entity. Differential diagnosis with other lesions in the sellar/parasellar region, through clinical, histopathological, immunohistochemical, and imaging is challenging but essential for adequate treatment. CASE REPORT This case report describes a 58-year-old patient with the previous diagnosis of follicular thyroid carcinoma, with metastasis to cervical lymph nodes, bone, and lung, initially evolving to left palpebral ptosis. In the investigation, laboratory tests showed hypopituitarism, and magnetic resonance imaging of the skull showed a suprasellar formation measuring 2.2×3.5×2.5 cm, which increased in size in a few months. The patient underwent transcranial neurosurgery and subsequent immunohistochemical analysis, which confirmed pituitary metastasis of follicular thyroid carcinoma. The patient underwent chemotherapy and radiotherapy but died 26 months after the onset of symptoms. CONCLUSIONS The differential diagnosis of pituitary metastasis from a benign lesion is difficult. Therefore, a careful analysis of the history and clinical evolution, use of complementary imaging tests, and, where possible, the histopathological and immunohistochemical analysis of the lesion for diagnostic elucidation are necessary.
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Affiliation(s)
- Juliana Souza Mota
- Department of Endocrinology and Metabolism, University Hospital of the Federal University of Maranhão, Presidente Dutra Unit, São Luís, Maranhão, Brazil
| | - Adriana de Sá Caldas
- Department of Endocrinology and Metabolism, University Hospital of the Federal University of Maranhão, Presidente Dutra Unit, São Luís, Maranhão, Brazil
| | | | - Manuel Dos Santos Faria
- Department of Endocrinology and Metabolism, University Hospital of the Federal University of Maranhão, Presidente Dutra Unit, São Luís, Maranhão, Brazil
| | - Carla Souza Pereira Sobral
- Department of Endocrinology and Metabolism, University Hospital of the Federal University of Maranhão, Presidente Dutra Unit, São Luís, Maranhão, Brazil
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Ma HS, Wang EL, Xu WF, Yamada S, Yoshimoto K, Qian ZR, Shi L, Liu LL, Li XH. Overexpression of DNA (Cytosine-5)-Methyltransferase 1 (DNMT1) And DNA (Cytosine-5)-Methyltransferase 3A (DNMT3A) Is Associated with Aggressive Behavior and Hypermethylation of Tumor Suppressor Genes in Human Pituitary Adenomas. Med Sci Monit 2018; 24:4841-4850. [PMID: 30002361 PMCID: PMC6069575 DOI: 10.12659/msm.910608] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Alteration of DNA methylation of tumor suppressor genes (TSGs) is one of the most consistent epigenetic changes in human cancers. DNMTs play several important roles in DNA methylation and development of cancers. Regarding DNMTs protein expressions, little is known about the clinical significance and correlation with promoter methylation status of TSGs in human pituitary adenomas. Material/Methods We analyzed the protein expression of 3 DNMTs using immunohistochemistry and assessed DNA hypermethylation of RASSF1A, CDH13, CDH1, and CDKN2A (p16) in 63 pituitary adenomas. We examined associations between DNMTs expression and clinicopathological features or promoter methylation status of TSGs. Results Overexpression of DNMTs was detected in pituitary adenomas. Frequencies of DNMT1 overexpression were significantly higher in macroadenomas, invasive tumors, and grade III and IV tumors. DNMT3A was frequently detected in invasive tumors and grade IV tumors. In addition, DNMT1 and DNMT3A were frequently detected in high-methylation tumors. Furthermore, in multivariate logistic regression, the significant association between DNMT1 or DNMT3A and high-methylation status persisted after adjusting for clinicopathological features. Conclusions Our findings suggested that tumor overexpression of DNMT1 and DNMT3A is associated with tumor aggressive behavior and high-methylation status in pituitary adenomas. Our data support a possible role of DNMT1 and DNMT3A in TSG promoter methylation leading to pituitary adenoma invasion and suggest that inhibition of DNMTs has the potential to become a new therapeutic approach for invasive pituitary adenoma.
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Affiliation(s)
- Hou-Shi Ma
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Sciences, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, China (mainland).,Zhejiang Provincial Key Laboratory of Applied Enzymology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, Zhejiang, China (mainland)
| | - Elaine Lu Wang
- Department of Human Pathology, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima City, Tokushima, Japan.,Department of Legal Medicine, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Wen-Fei Xu
- Zhejiang Provincial Key Laboratory of Applied Enzymology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, Zhejiangb, China (mainland)
| | - Shozo Yamada
- Department of Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Katsuhiko Yoshimoto
- Department of Medical Pharmacology, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima City, Tokushima, Japan
| | - Zhi Rong Qian
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Long Shi
- Zhejiang Provincial Key Laboratory of Applied Enzymology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, Zhejiang, China (mainland)
| | - Li-Li Liu
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Sciences, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, China (mainland)
| | - Xu-Hui Li
- Zhejiang Provincial Key Laboratory of Applied Enzymology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, Zhejiang, China (mainland)
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19
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Ma Z, Qi Z, Shan Z, Li J, Yang J, Xu Z. The role of CRP and ATG9B expression in clear cell renal cell carcinoma. Biosci Rep 2017; 37:BSR20171082. [PMID: 28923830 PMCID: PMC5686392 DOI: 10.1042/bsr20171082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 12/28/2022] Open
Abstract
The purpose of the study is to investigate the correlation between the expression of C-reactive protein (CRP) and autophagy-related 9B (ATG9B) and pathological features of clear cell renal cell carcinoma (CCRCC) patients. We also intended to explore the effects of manipulated expression of CRP and ATG9B on the apoptosis and cell cycle progression of CCRCC cell line. ATG9B expression in CCRCC tissues and adjacent renal tissues was analyzed by immunohistochemistry (IHC). Gene expression was determined at transcription and translational levels using real-time quantitative PCR (RT-qPCR) and Western blot. The association between CRP/ATG9B expression and clinical-pathological parameters including age, gender, pathological grades, TNM stage and distant metastasis of the patients was assessed by correlation analysis. siRNA and overexpression plasmids construction were used to manipulate the expression of CRP in human CCRCC cell line 786-O. Cell apoptosis and cell cycle progression were determined using flow cytometry (FCM) and Hoechst 33258 staining. CRP expression correlates with ATG9B expression. The expression of CRP and ATG9B are significantly correlated with TNM staging, distant metastasis, and survival time of CCRCC patients. A high-level of CRP indicates a poor overall survival (OS). In addition, CRP expression influences cell cycle and apoptosis of CCRCC cells. The study reveals that CRP might be a CCRCC development promoter. In addition, there is a close relationship between CRP and ATG9B in CCRCC carcinogenesis.
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Affiliation(s)
- Zheng Ma
- Department of Urology, Liaocheng People's Hospital, Liaocheng 252000, Shandong, China
| | - Zengguang Qi
- Department of Urology, Guanxian Center Hospital, Liaocheng 252500, Shandong, China
| | - Zhengfei Shan
- Department of Urology, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, Shandong, China
- Department of Organ Transplantation, the affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, Shandong, China
| | - Jiangsong Li
- Department of Urology, Liaocheng People's Hospital, Liaocheng 252000, Shandong, China
| | - Jing Yang
- Department of Pediatrics, Liaocheng People's Hospital, Liaocheng 252000, Shandong, China
| | - Zhonghua Xu
- Department of Urology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
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