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Sitoci-Ficici KH, Sippl C, Prajsnar A, Saffour S, Linsler S. Sellar metastasis: A rare intraoperative finding - surgical treatment, strategies and outcome. Clin Neurol Neurosurg 2024; 241:108280. [PMID: 38636360 DOI: 10.1016/j.clineuro.2024.108280] [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: 03/02/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The sellar region, though uncommon for metastatic spread, may become more prevalent due to longer survival of patients with metastatic malignancies. Compression of adjacent vital anatomy can cause disabling symptoms and endocrine disturbances, leading to significant morbidity METHODS: This study analyzed sellar pathologies treated via endonasal approach from January 2011 to December 2021 to assess the incidence of sellar metastases. Patient demographics, presenting symptoms, radiological and histological findings, management, and outcomes were evaluated RESULTS: Among 334 patients treated during the study period, eight (2.3 %) had metastases confirmed histopathologically, with one having a known malignant tumor history. Preoperative imaging suspected malignancy or metastasis in two cases. Diagnosis was unexpectedly confirmed in 57 % of cases. Subtotal resection was achieved in three cases, near-total resection in one. Mean follow-up was 2.4 years, with 71 % mortality CONCLUSIONS: The sellar region can manifest metastatic disease, with sellar symptoms potentially indicating neoplastic disease onset. Rapid hormonal dysfunction or ophthalmoplegia suggests metastasis, even without a known primary. Further meta analysis of reported cases is necessary to determine the incidence and optimal treatment of these rare metastases.
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Affiliation(s)
| | - Christoph Sippl
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg, Germany; Klinik für Neurochirurgie, Klinikum Bayreuth, Medizincampus Oberfranken FAU, Erlangen, Germany
| | - Anna Prajsnar
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Safwan Saffour
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg, Germany; Klinik für Neurochirurgie, Klinikum Bayreuth, Medizincampus Oberfranken FAU, Erlangen, Germany
| | - Stefan Linsler
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg, Germany; Klinik für Neurochirurgie, Klinikum Bayreuth, Medizincampus Oberfranken FAU, Erlangen, Germany.
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2
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Haberbosch L, Schmid S, Hubertus V, Soll D, Acker G, Dottermusch M, Jensen M, Maurer L, Spranger J, Mai K, Vajkoczy P, Saeger W, Strasburger CJ. Metastases to the pituitary gland: insights from the German pituitary tumor registry. Pituitary 2023; 26:708-715. [PMID: 37899389 PMCID: PMC10665242 DOI: 10.1007/s11102-023-01361-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 10/31/2023]
Abstract
Metastatic involvement of the pituitary gland is a rare but clinically significant phenomenon, that often poses diagnostic and therapeutic challenges. The aim of this study was to provide a comprehensive analysis of the origin of pituitary metastases using data from the German Pituitary Tumor Registry, one of the globally largest collections of pituitary pathology specimens. Here, we report data from a retrospective analysis of patients with metastases to the pituitary registered between 1990 and 2022. Out of 17,896 pituitary cases in the registry during this period, a total of 96 metastases to the pituitary gland were identified, accounting for 0.5% of all pituitary tumors in the registry. The mean age of the patients was 64 years. Breast cancer was identified as the primary tumor in 25% of total cases (n = 24/96) and in 50% of female patients. The second most prevalent primary tumor was lung cancer (18.75%, n = 18/96), followed by renal cell carcinoma (14.58%, n = 14/96). In comparison to current meta-analyses, this cohort shows a higher prevalence of metastases originating from the kidney. Furthermore, in contrast to the existing literature, no case of primary thyroid tumor was identified. Our study highlights the importance of pituitary metastases as a differential diagnosis in patients presenting with pituitary tumors.
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Affiliation(s)
- Linus Haberbosch
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany.
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany.
- BIH Charité Junior Digital Clinician Scientist Program, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1, Berlin, 10117, Germany.
| | - Simone Schmid
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
| | - Vanessa Hubertus
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
- BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1, Berlin, 10117, Germany
| | - Dominik Soll
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
| | - Güliz Acker
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
| | - Matthias Dottermusch
- Institute of Neuropathology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Marie Jensen
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
| | - Lukas Maurer
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
| | - Knut Mai
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
| | - Peter Vajkoczy
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
| | - Wolfgang Saeger
- Institute of Neuropathology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Institute of Pathology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Christian J Strasburger
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
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3
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Asim SA, Elashaal AA. Metastasis of lung adenocarcinoma to the pituitary gland. Radiol Case Rep 2023; 18:3487-3491. [PMID: 37588239 PMCID: PMC10425746 DOI: 10.1016/j.radcr.2023.07.025] [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: 04/30/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023] Open
Abstract
Pituitary metastasis (PM) is rare occurrence and accounts for <1% of all intracranial metastatic lesions. In this study, we highlight the importance of considering atypical sites for lung adenocarcinoma metastasis by presenting a case of a 54-year-old male who was diagnosed with PM 15 months after being diagnosed with stage IV lung adenocarcinoma with metastasis to the spine, pelvis, left frontal lobe, and right occipital lobe. He was on a prolonged course of chemotherapy during those 15 months and received palliative radiation for his brain metastasis with subsequent remission after 5 months following his initial diagnosis. The pituitary lesion was picked up as an incidental finding on a routine staging magnetic resonance imaging (MRI) 10 months after his brain metastasis remission. The patient successfully underwent trans-sphenoidal pituitary lesion resection. This case emphasizes the importance of routine surveillance and examination of atypical sites of metastasis even in patients undergoing a prolonged course of chemotherapy.
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Affiliation(s)
- Syed Anam Asim
- Windsor Regional Hospital, 1030 Ouellette Ave, Windsor, ON N9A 1E1, Canada
| | - Abdurrahim Abdalla Elashaal
- Windsor Regional Hospital, 1030 Ouellette Ave, Windsor, ON N9A 1E1, Canada
- Schulich School of Medicine and Dentistry, 455 California Ave, Windsor, ON N9B 2Y9, Canada
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4
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Yang K, Begley SL, Lynch D, Ye V, Saini J, Gutierrez E, Vialet J, Millar BA, Conrad T, Laperriere N, Bernstein M, Zadeh G, Shultz DB, Kongkham PN. Pituitary metastases: a case series and scoping review. Pituitary 2023; 26:538-550. [PMID: 37698666 DOI: 10.1007/s11102-023-01349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To understand the natural history and optimal treatment strategy for pituitary gland metastasis. METHODS We performed both a retrospective chart review of patients treated at our institution and a scoping review of the topic. RESULTS The retrospective review identified seven patients with an average age of 59.6 years. Primary histologies included breast cancer (4), melanoma (1), renal cell carcinoma (1), and sarcoma (1). Two patients had anterior pituitary endocrine dysfunction, one of whom was the only patient with visual symptoms. All patients were treated with radiosurgery and two also underwent surgical resection. Overall survival ranged from 6.5 to 117 months. Literature review identified 166 patients from 71 studies. The most common primary cancer was lung (27.7%), followed by breast (18.7%) and renal (14.5%) cancer. 107 presented with endocrine dysfunction, including 41 cases of diabetes insipidus and 55 cases of hypopituitarism. 110 presented with visual compromise. 107 patients received radiotherapy, 96 underwent surgical resection and 44 received systemic chemotherapy/immunotherapy. Surgery was significantly associated with an increased likelihood of vision improvement and a decreased likelihood of endocrine normalization. Radiographic regression predicted visual improvement. Median overall survival was 9.9 months (range: 0.2-96). CONCLUSIONS This scoping review showed that both radiosurgery and surgical resection have been frequently used to treat pituitary metastases with good response. Vision improvement is more likely to happen following surgical resection, likely at the expense of endocrine dysfunction. Despite treatment and radiographic response, patient survival remains less than a year.
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Affiliation(s)
- Kaiyun Yang
- Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Sabrina L Begley
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Daniel Lynch
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Vincent Ye
- Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Jasleen Saini
- Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Enrique Gutierrez
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Jaclyn Vialet
- Medical Library, North Shore University Hospital, Manhasset, NY, USA
| | - Barbara-Ann Millar
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Tatianna Conrad
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Normand Laperriere
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Mark Bernstein
- Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Gelareh Zadeh
- Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - David B Shultz
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Paul N Kongkham
- Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.
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5
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Alali I, Al-Sarraj A, Kabalan Y. Diabetes Insipidus due to Metastases of Undiagnosed Lung Cancer: A Case Report from Syria. Case Rep Endocrinol 2023; 2023:1482675. [PMID: 37731967 PMCID: PMC10508995 DOI: 10.1155/2023/1482675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023] Open
Abstract
Pituitary metastases (PM) are extremely uncommon, accounting for less than 1% of all intracranial metastases. PM of an undiagnosed malignancy can commonly present with symptoms of hormonal deficiencies, central diabetes insipidus, and/or visual symptoms. Lung and breast malignancies are the most common cancers associated with PM. Despite advances in diagnostic and therapeutic options, the prognosis remains poor and is influenced by primary malignancy and treatment methods. We report a case of a patient with PM from lung cancer who had polyuria, polydipsia, and nonspecific symptoms. A full evaluation confirmed central diabetes insipidus, hypogonadism, and metastatic lung cancer. We also discuss the current literature on PM diagnosis and management, emphasizing the need for a comprehensive evaluation of all available data. This is the first case of PM reported from Syria, to our knowledge.
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Affiliation(s)
- Ibrahim Alali
- Endocrinology Department, Al-Assad University Hospital, Damascus University, Damascus, Syria
| | - Alaa Al-Sarraj
- Endocrinology Department, Al-Assad University Hospital, Damascus University, Damascus, Syria
| | - Younes Kabalan
- Endocrinology Department, Al-Assad University Hospital, Damascus University, Damascus, Syria
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6
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Ilerhunmwuwa NP, Wasifuddin M, Perry J, Hakobyan N, Inyang L, Zavgorodneva Z, Gasparyan L, Tahir M. Pituitary Metastases From Differentiated Thyroid Cancers: A Systematic Review. World J Oncol 2023; 14:165-173. [PMID: 37350806 PMCID: PMC10284638 DOI: 10.14740/wjon1593] [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: 04/06/2023] [Accepted: 05/12/2023] [Indexed: 06/24/2023] Open
Abstract
Background Pituitary metastasis (PM) from differentiated thyroid cancer (DTC) is extremely rare and may adversely affect outcomes. We aimed to assess the characteristics and outcomes of patients with PM from DTC. Methods We systematically reviewed the literature on publications on PM and the different DTC histologic types (papillary, follicular, and Hurthle cell cancers). Three databases (PubMed, Embase, and Scopus) were searched for articles published from 1967 to 2022. Survival time was estimated as the period from the first treatment of PM to the time of death or last follow-up. Results Twenty-five articles comprising 27 cases that met the eligibility criteria were identified using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The median age of the patients was 60 years (23 - 86). A preponderance of females (66.7%) with PM most commonly reported papillary thyroid cancer (55.6%). This was followed by follicular thyroid cancer (37.0%) and Hurthle cell cancer (7.4%). The most common presentations were headache, nausea, and vomiting, with visual symptoms in 44.4%. Diabetes insipidus was an infrequent finding (7.4%). The median time from diagnosis or first treatment of DTC to the diagnosis of PM was 3 years (0 - 25). The most common endocrine abnormality was hyperprolactinemia (63.2%), while the most frequently deficient hormone was luteinizing hormone (50%). The most common treatment modality for PM was a combination of radiotherapy and surgery with or without radio-iodine. At the end of the follow-up, 30% of the patients died. Only 33.3% of the patients achieved complete resolution of symptoms. The overall median survival time was 12 months (3 - 108). There was a moderate inverse correlation between the age of patients and survival, which was, however, not statistically significant (rs = -0.45, P = 0.103). Conclusion PM from DTC is extremely rare, and Hurtle cell cancer appears to be the least associated with PM. Diabetes insipidus is a rare initial manifestation of PM from DTC. Complete resolution of symptoms is less likely to be achieved in PM from DTC. Older age may confer an increased survival tendency, probably due to more intracranial space volume in older people compared to the younger population. Larger studies are needed to examine the relationship between age and survival in PM from DTC. Also, more observational data are required to determine the predictors of survival and compare the efficacy of the different treatment modalities in patients with PM from DTC.
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Affiliation(s)
| | - Mustafa Wasifuddin
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Jamal Perry
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Narek Hakobyan
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Lawrence Inyang
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Zhanna Zavgorodneva
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Lilit Gasparyan
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Muhammad Tahir
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
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7
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Wei Z, Jose S, Abou-Al-Shaar H, Deng H, Luy D, Kondziolka D, Niranjan A, Lunsford LD. Intracerebral and pituitary metastatic eccrine carcinoma: prolonged survival using stereotactic radiosurgery. Br J Neurosurg 2023:1-6. [PMID: 36705060 DOI: 10.1080/02688697.2023.2170327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/26/2022] [Accepted: 01/15/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE Eccrine gland carcinoma (EC) is a rare skin neoplasm that uncommonly spreads to the brain or pituitary gland. We describe the role of multiple stereotactic radiosurgery (SRS) procedures to manage recurrent brain metastases of this rare disease. MATERIALS AND METHODS Retrospective chart review was completed to obtain details for this report. The study was performed under IRB study on medical record only and was exempt from patient's consent. RESULTS AND CONCLUSIONS A 59-year-old female underwent surgical excision of a right parietal scalp EC. Over the next 13 years, the patient underwent initial fractionated whole brain radiation therapy after she developed multiple brain metastases followed by systemic chemotherapy for extracranial disease. Because of repeated development of new brain disease, three SRS procedures were performed to treat a total of 50 brain metastases and a pituitary metastasis (PM). The patient expired from progressive systemic cancer spread 13 years after her initial surgical excision. Due to the rarity of metastatic EC to the brain, no standard treatment paradigm has emerged. Using multimodality options that included local excision of the original skin tumor, followed by radiation, systemic chemotherapy, and three SRS procedures, long-term survival was possible in this unusual case.
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Affiliation(s)
- Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shalini Jose
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hansen Deng
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Diego Luy
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Douglas Kondziolka
- Department of Neurological Surgery, NYU Langone Health, New York, NY, USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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8
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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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9
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Maamri K, Hadj Taieb MA, Ghorbel M, Trifa A, Elkahla G, Darmoul M. Apoplexy in pituitary metastasis revealing a lung carcinoma. Respirol Case Rep 2023; 11:e01080. [PMID: 36605538 PMCID: PMC9808143 DOI: 10.1002/rcr2.1080] [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: 11/17/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
Pituitary metastasis (PM) is an uncommon manifestation of systemic malignant tumours. It is the least common site of intracranial metastases. As PM has no clinical or radiological pathognomonic features, their diagnosis is challenging. Herein, we present a rare case of a PM unveiling lung cancer. A 60-year-old male with no medical history of malignancy was admitted with a sudden headache, retro-orbital pain, and a severe loss of both eyes' visual acuity. After proper investigations and endoscopic resection of the sellar mass, the diagnosis was confirmed to be pituitary metastasis of lung carcinoma. PM can be the initial presentation of an otherwise unknown malignancy. Their diagnosis and management are complex and depend on many factors. Endoscopic surgical resection provides histopathological proof, helps with symptomatic relief, and improves the quality of life but has no effect on survival.
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Affiliation(s)
- Kais Maamri
- Neurosurgery DepartmentFatouma Bourguiba HospitalMonastirTunisia
| | | | - Mohamed Ghorbel
- Neurosurgery DepartmentFatouma Bourguiba HospitalMonastirTunisia
| | - Amine Trifa
- Neurosurgery DepartmentFatouma Bourguiba HospitalMonastirTunisia
| | - Ghassen Elkahla
- Neurosurgery DepartmentFatouma Bourguiba HospitalMonastirTunisia
| | - Mehdi Darmoul
- Neurosurgery DepartmentFatouma Bourguiba HospitalMonastirTunisia
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10
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Stereotactic radiosurgery for pituitary and cavernous sinus metastases. J Neurooncol 2023; 161:175-184. [PMID: 36617600 DOI: 10.1007/s11060-023-04236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
PURPOSE Metastases extending to the pituitary gland and cavernous sinus are extremely rare; however, advances in neuroimaging have increased the reported incidence. Stereotactic radiosurgery (SRS) affords the precise delivery of focused radiation to minimize adverse radiation effects. This study assessed the efficacy and safety of SRS in the treatment of pituitary and cavernous sinus metastases. METHODS Analysis was performed on 23 patients with pituitary and cavernous sinus metastases who underwent treatment using SRS between 1996 and 2021. The cohort was categorized into 2 groups in terms of metastasis location: pituitary involvement (Group 1, n = 11) and cavernous sinus involvement (Group 2, n = 12). Overall survival, local tumor control, and distal tumor control rates were compared between the two groups using Kaplan-Meier analysis. RESULTS The median age of the cohort was 52.2 years and the median tumor volume was 4.5 mL. Overall survival rates were as follows: 1 year (72.9%), 2 years (51.8%), and 3 years (45.3%). Local tumor control rates were as follows: 1 year (82.3%), 2 years (82.3%), and 3 years (65.9%). Visual deficit and hypopituitarism were the most common presentations in Group 1, whereas cranial nerve deficit was the most common presentation in Group 2. CONCLUSIONS SRS appears to be a safe and effective therapy for the treatment of pituitary and cavernous sinus metastases. GKRS is a relatively simple procedure, which places minimal stress on the patient, thereby facilitating further anti-cancer treatment. Considering the limited survival duration in cases of metastasis, it is very likely that post-GKRS complications (e.g., new onset cranial nerve deficit and hypopituitarism) would not become an issue before patient passes away.
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11
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Wei Z, Yavan S, Deng H, Mallela AN, Gersey ZC, Shariff RK, Fazeli PK, Niranjan A, Lunsford LD, Abou-Al-Shaar H. The role of stereotactic radiosurgery in the multidisciplinary management of pituitary metastases. Pituitary 2022; 25:948-958. [PMID: 36203008 DOI: 10.1007/s11102-022-01279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE This study evaluates the role and outcomes of Gamma Knife radiosurgery (GKRS) in the management of pituitary metastases. METHODS The records of brain metastases patients who underwent GKRS at the University of Pittsburgh Medical Center during the 10-year interval of 2010-2020 were systematically reviewed. Outcome measures included patient survival, tumor control rate, pituitary hormonal outcomes, visual outcomes, adverse radiation effects (AREs), and need for adjuvant therapy. RESULTS Eighteen patients with pituitary metastases (eight male; median age of 65.5 years) had sufficient clinical follow-up for analysis. The most common primary cancers were non-small cell lung cancer (n = 6) and breast cancer (n = 4). Patients presented with headache (n = 9) and visual difficulties (n = 6). One patient underwent resection before GKRS. The median tumor volume was 0.78 cc (range 0.04-6.42 cc). The median overall survival after GKRS was 6.5 months (range 0.5-58 months). The overall survival after GKRS at 3-, 6-, and 12-months were 72.2%, 50.0% and 38.9%, respectively. The tumor control rate was 94.4%. One patient had further progression that required additional GKRS. None of the patients developed AREs after GKRS. CONCLUSION GKRS is an effective treatment modality for the multidisciplinary management of patients with pituitary metastases. This minimally-invasive strategy is associated with optimal tumor control rate and low risk to adjacent optic nerves or neurovascular structures.
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Affiliation(s)
- Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA
| | - Sila Yavan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA
| | - Hansen Deng
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA
| | - Arka N Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA
| | - Zachary C Gersey
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA
| | - Rimsha K Shariff
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Division of Endocrinology and Metabolism, Neuroendocrinology Unit, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Pouneh K Fazeli
- Division of Endocrinology and Metabolism, Neuroendocrinology Unit, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA.
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12
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Sugg K, Diab W, Kappagantu A, Yazdanpanah O. Binocular Diplopia: An Unusual Presentation of Squamous Cell Carcinoma of the Lung. Cureus 2022; 14:e27008. [PMID: 35989842 PMCID: PMC9386329 DOI: 10.7759/cureus.27008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/20/2022] Open
Abstract
Here, we discuss the case of a 72-year-old male with a known history of COPD who presented with one month of binocular diplopia and headache. The initial clinical investigation discovered destructive intraosseous lesions within the sellar and para-sellar (SPS) regions, suggesting primary versus metastatic intracranial lesions. Further examination revealed a mass in the right lung, with subsequent biopsy confirming squamous cell carcinoma (SCC) of the lung as the primary site of malignancy. The SPS regions of the basicranium, while well-documented to be associated with various primary neoplasms, rarely serve as sites of metastasis. Throughout this article, we will review the pathophysiology of squamous cell lung cancer, current understandings of SPS metastasis, and considerations of metastatic lung SCC management.
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13
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Hirayama M, Ishida A, Inoshita N, Shiramizu H, Yoshimoto H, Kato M, Tanaka S, Matsuo S, Miki N, Ono M, Yamada S. Apoplexy in sellar metastasis from papillary thyroid cancer: A case report and literature review. Surg Neurol Int 2022; 13:253. [PMID: 35855167 PMCID: PMC9282727 DOI: 10.25259/sni_131_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/17/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Pituitary metastasis from papillary thyroid cancer (PTC) is rare and only a few cases have been reported. Case Description: We report the case of a patient who presented with visual dysfunction and panhypopituitarism. Magnetic resonance imaging revealed a pituitary tumor and hydrocephalus. Transsphenoidal surgery had been indicated, but his surgery had been postponed due to COVID-19 pandemic. During that waiting period, he showed pituitary apoplexy with consciousness disturbance, resulting in acute adrenal insufficiency and diabetes insipidus. He was urgently hospitalized and underwent transsphenoidal surgery. Rapid and permanent pathological examinations have confirmed metastasis of PTC to the pituitary. The patient also underwent serial thyroidectomy. He was also suspected to have secondary hydrocephalus and underwent lumboperitoneal shunting after excluding cerebrospinal fluid metastasis. Thereafter, his cognitive dysfunction and performance status improved dramatically. Conclusion: To the best of our knowledge, this is the first patient with PTC who developed pituitary apoplexy secondary to metastasis.
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Affiliation(s)
- Masahiro Hirayama
- Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
| | - Atsushi Ishida
- Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
| | - Naoko Inoshita
- Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
| | - Hideki Shiramizu
- Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
| | - Haruko Yoshimoto
- Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
| | - Masataka Kato
- Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
| | - Satoshi Tanaka
- Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
| | - Seigo Matsuo
- Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
| | - Nobuhiro Miki
- Hypothalamic and Pituitary Center, Moriyama Neurosurgical Center Hospital, Tokyo, Japan
| | - Masami Ono
- Hypothalamic and Pituitary Center, Moriyama Neurosurgical Center Hospital, Tokyo, Japan
| | - Shozo Yamada
- Hypothalamic and Pituitary Center, Moriyama Neurosurgical Center Hospital, Tokyo, Japan
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14
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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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15
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Han D, Zhao K, Yang Q, Zhang L, Fei S. Secondary mutant ALK-I1171s in pituitary metastases from a patient with ALK fusion-positive advanced lung adenocarcinoma: A case report and literature review. Front Oncol 2022; 12:1016320. [PMID: 36324562 PMCID: PMC9619101 DOI: 10.3389/fonc.2022.1016320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/29/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pituitary metastasis accounts for a very low percentage of cases of brain metastasis from lung cancer, and there are uncertainties and challenges in diagnosis and treatment. We hope to shed some light on the diagnosis and treatment by reporting a case of ALK fusion mutation-positive lung cancer pituitary metastasis. CASE PRESENTATION We report a 48-year-old female patient with an initial diagnosis of stage IVB lung adenocarcinoma with ALK fusion. The patient developed headache, dizziness, hypopituitarism and hyperprolactinemia one year after treatment with crizotinib. Later, the patient underwent neurosurgical resection of the pituitary tumor and then symptomatic relief. Postoperative pathology suggested pituitary metastasis, and the next-generation gene sequencing conducted on the pituitary metastasis indicated that secondary drug resistance mutation ALK-I1171s occurred after the ALK fusion gene. CONCLUSION In this article, we present a patient with suspected pituitary metastases with lung cancer. The progression to pituitary mass resection and next-generation gene sequencing of the pituitary metastasis are suggestive for further diagnosis and treatment.
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Affiliation(s)
| | | | | | | | - Shihong Fei
- *Correspondence: Shihong Fei, ; Liling Zhang,
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16
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Wong PS, Rajoo S, Achmad Sankala H, Long Bidin MB. Unusual presentation of lung carcinoma with pituitary metastasis: a challenging diagnosis and sodium management dilemmas. ENDOCRINE ONCOLOGY (BRISTOL, ENGLAND) 2022; 2:K15-K20. [PMID: 37435455 PMCID: PMC10259289 DOI: 10.1530/eo-22-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/05/2022] [Indexed: 07/13/2023]
Abstract
Summary Pituitary metastasis (PM) is a rare complication of an advanced malignancy. Albeit rare, PM can be more detected and achieve a longer survival rate through frequent neuroimaging and newer oncology therapies. Lung cancer is the most frequent primary site, followed by breast and kidney cancers. Patients with lung cancer generally present with respiratory symptoms and are commonly diagnosed at an advanced stage already. Nevertheless, physicians should be mindful of other systemic manifestations as well as signs and symptoms related to metastatic spread and paraneoplastic syndromes. Herein, we report the case of a 53-year-old woman who presented with PM as the first sign of an undiagnosed lung cancer. Initially, her condition was a challenging diagnosis and was even complicated with diabetes insipidus (DI), which can present as severe hyponatremia when coexisting with adrenal insufficiency. This case also highlights that treating DI with antidiuretic hormone (ADH) replacement was complicated by extreme difficulties in attaining satisfactory sodium and water balance during the clinical course, with the possibility of coexistent DI and syndrome of inappropriate ADH secretion because of the underlying lung cancer. Learning points When patients present with pituitary mass and diabetes insipidus (DI), pituitary metastasis should be considered as an initial differential diagnosis. DI caused by pituitary adenoma is rare and is typically a late finding.DI can present as severe hyponatremia when coexisting with adrenal insufficiency.Cortisol can directly inhibit endogenous antidiuretic hormone (ADH) secretion. Patients with adrenocorticotropic hormone deficiency will have increased tonic ADH activity and subsequently reduced capacity for free-water excretion. However, when on steroid therapy, patients should be monitored for possible DI because steroids can restore free-water excretion.A substantial change in serum sodium after desmopressin treatment should eliminate the possibility of desmopressin overdose or coexistence of DI and syndrome of inappropriate ADH secretion in patients with lung cancer. Therefore, frequent monitoring of serum sodium concentrations is crucial.
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Affiliation(s)
- Poh Shean Wong
- Endocrine Unit, Medical Department, Hospital Kuala Lumpur, Malaysia
| | - Subashini Rajoo
- Endocrine Unit, Medical Department, Hospital Kuala Lumpur, Malaysia
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17
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Zaky M, Compton RA, Alpertunga I, Tischler AS, Tracy JC. Salivary gland adenocarcinoma metastatic to the pituitary gland. Am J Otolaryngol 2021; 42:103153. [PMID: 34242881 DOI: 10.1016/j.amjoto.2021.103153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 10/21/2022]
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18
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Kameda-Smith MM, Zhang E, Lannon M, Algird A, Reddy K, Lu JQ. Pituitary metastasis: From pathology to clinical and radiological considerations. J Clin Neurosci 2021; 93:231-240. [PMID: 34656254 DOI: 10.1016/j.jocn.2021.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE A review of the literature with respect to pituitary metastases (PM) with clinical and radiological considerations are summarized to facilitate clinical decision making in the management of PM METHODS: A review of literature associated with PM and tumour to tumour metastases in the English literature was reviewed and summarized RESULTS: Pituitary metastases account for 1.0-3.6% of all surgically treated pituitary lesions. Often identified in parallel with extensive disseminated disease, once diagnosed, the prognosis is generally poor, although survival is highly heterogeneous and dependent on the primary tumor histology. Within this anatomical region is also the observation of tumor-to-tumor metastases and collision tumours. Both the tumor macro- and microenvironment play central roles to the progression of disease with distinctive radiological features that may suggest a metastatic sellar lesion as opposed to a primary pituitary lesion. Surgical resection is the first line of therapy followed by adjuvant chemoradiotherapy and endocrinological evaluation for hormonal supplementation CONCLUSION: PMs are relatively rare but important oncological entities representing disseminated disease in the majority of cases. Careful consideration of the relevant clinical history and radiological features can aid the clinician differentiate between a metastatic lesion to the pituitary region and a primary pituitary tumor. While surgical resection is first line therapy, stereotactic radiosurgery in carefully selected patients is emerging as a viable alternative.
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Affiliation(s)
| | - E Zhang
- McMaster University, Canada; Diagnostic Imaging, Canada
| | - M Lannon
- McMaster University, Canada; Departments of Surgery, Canada
| | - A Algird
- McMaster University, Canada; Departments of Surgery, Canada
| | - K Reddy
- McMaster University, Canada; Departments of Surgery, Canada
| | - J-Q Lu
- McMaster University, Canada; Neuropathology, Canada
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19
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Bailey D, Mau C, Zacharia B. Pituitary Metastasis From Urothelial Carcinoma: A Case Report and Review of the Diagnosis and Treatment of Pituitary Metastases. Cureus 2021; 13:e17574. [PMID: 34646629 PMCID: PMC8481102 DOI: 10.7759/cureus.17574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 12/05/2022] Open
Abstract
The sellar and parasellar regions are a rare site of brain metastasis, most commonly from breast and lung cancer. Pituitary metastasis (PM) often presents as the first sign of metastatic disease but may herald early disseminated cancer. The diagnosis of PM requires differentiation from a benign pituitary adenoma. Although this may be proven definitively via surgical biopsy, a constellation of clinical findings including oculomotor palsy, visual disturbances, retroorbital pain, and diabetes insipidus is more suggestive of PM. Imaging is neither sensitive nor specific for differentiation but may inform the broader clinical picture. Due to its rarity, treatment guidelines for PM lack consensus, often including a mixture of radiation and surgery. Gross resection is challenging because of the vascular, invasive nature of these lesions. Stereotactic radiosurgery may be used to good effect either alone or in addition to resection. Even with treatment, the prognosis is poor. In this article, we present the third reported case of urothelial carcinoma metastasis to the pituitary. In addition, we review the clinical presentation, diagnosis, and treatment options including surgical resection and radiosurgery.
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Affiliation(s)
- David Bailey
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Christine Mau
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Brad Zacharia
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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20
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Du H, Jia A, Ren Y, Gu M, Li H, Sun M, Tang T, Liu H, Bai J. Endometrial adenocarcinoma metastatic to the pituitary gland: a case report and literature review. J Int Med Res 2021; 48:300060520924512. [PMID: 32500767 PMCID: PMC7278323 DOI: 10.1177/0300060520924512] [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] [Indexed: 11/16/2022] Open
Abstract
Pituitary metastases are rare, and metastatic pituitary lesions originating from endometrial adenocarcinoma are extremely rare. These lesions can be mistaken for pituitary adenomas and their diagnosis can be very difficult. Pituitary metastases mostly affect the posterior lobe and patients may develop diabetes insipidus. Patients with endometrial cancer complicated with diabetes, including poor glycemic control, may also suffer from thirst, making it more difficult to diagnose diabetes insipidus. A 68-year-old woman who was being followed-up for primary endometrial adenocarcinoma was admitted for gradually worsened polyuria and polydipsia. Her laboratory findings were compatible with diabetes insipidus. Magnetic resonance imaging revealed thickening of the pituitary stalk, involvement of the superior pituitary gland, and disappearance of hyperintensity in the posterior lobe, indicating pituitary metastasis. Increased urine output and oral fluid intake in a patient with a diagnosis of carcinoma may indicate possible pituitary metastasis, and the hormonal insufficiency should be corrected to improve the patient’s quality of life.
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Affiliation(s)
- Hongquan Du
- Department of Endocrinology, Liaocheng People's Hospital, Liaocheng, China
| | - Aihua Jia
- Department of Pathology, Shanghai- Xuhui District Central Hospital, Fudan University, Shanghai, China
| | - Yuan Ren
- Department of Endocrinology, Liaocheng People's Hospital, Liaocheng, China
| | - Mingyong Gu
- Department of Endocrinology, Shen County No.2 Hospital, Liaocheng, China
| | - Haomin Li
- Department of Endocrinology, Liaocheng People's Hospital, Liaocheng, China
| | - Minghui Sun
- Department of Endocrinology, Liaocheng People's Hospital, Liaocheng, China
| | - Tian Tang
- Department of Endocrinology, Liaocheng People's Hospital, Liaocheng, China
| | - Haijuan Liu
- Department of Endocrinology, Liaocheng People's Hospital, Liaocheng, China
| | - Jie Bai
- Department of Endocrinology, Liaocheng People's Hospital, Liaocheng, China
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21
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Tanaka S, Hirabayashi T, Kimoto M, Hama M, Hachiya T, Gomi K. Gefitinib Treatment Was Unsuccessful for Central Diabetes Insipidus Due to Pituitary Metastasis of Lung Adenocarcinoma. Intern Med 2021; 60:1073-1076. [PMID: 33162476 PMCID: PMC8079922 DOI: 10.2169/internalmedicine.5643-20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We herein report a rare case of advanced lung adenocarcinoma with central diabetes insipidus due to pituitary metastasis. Although treatment with gefitinib was dramatically effective, the symptoms of diabetes insipidus did not improve. Radiotherapy for pituitary metastasis was effective to control diabetes insipidus; however, we could not cease the administration of 1-deamino-8-D-arginine vasopressin (DDAVP). It is important for physicians to positively consider radiotherapy for pituitary metastases even if favorable tumor control is achieved with chemotherapy when diabetes insipidus becomes clinically overt. Furthermore, continuous DDAVP administration may be needed to treat central diabetes insipidus.
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Affiliation(s)
- Shunnosuke Tanaka
- Department of Respiratory Medicine, Japanese Red Cross Society Suwa Hospital, Japan
| | - Taro Hirabayashi
- Department of Respiratory Medicine, Japanese Red Cross Society Suwa Hospital, Japan
| | - Masanobu Kimoto
- Department of Respiratory Medicine, Japanese Red Cross Society Suwa Hospital, Japan
| | - Mineyuki Hama
- Department of Respiratory Medicine, Japanese Red Cross Society Suwa Hospital, Japan
| | - Tsutomu Hachiya
- Department of Respiratory Medicine, Japanese Red Cross Society Suwa Hospital, Japan
| | - Kotaro Gomi
- Department of Radiation Oncology, Japanese Red Cross Society Suwa Hospital, Japan
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22
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Liu X, Wang R, Li M, Chen G. Pituitary Metastasis of Lung Neuroendocrine Carcinoma Mimicking Pituitary Adenoma:Case Report and Literature Review. Front Endocrinol (Lausanne) 2021; 12:678947. [PMID: 34335467 PMCID: PMC8317059 DOI: 10.3389/fendo.2021.678947] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/15/2021] [Indexed: 12/02/2022] Open
Abstract
Pituitary metastasis is an unusual situation in clinical practice, while the incidence is increasing with age. Breast cancer for women and lung cancer for men were the most frequent primary origins of pituitary metastasis. Diagnosing asymptomatic patients with unknown primary malignant origin is difficult, thus pituitary metastasis may be diagnosed as primary pituitary adenoma. Here, we report a case of a 65-year-old patient with visual changes and diabetes insipidus, showing an extensive mass in the sellar region which was initially thought to be a primary pituitary adenoma. Patient corticotropic deficits were corrected, and transnasal transsphenoidal surgery was adopted, leading to total tumor resection. Tumor texture during surgical procedure was similar to that of pituitary adenoma. However, the histopathological and immunohistochemistry results suggested it as a pituitary metastasis from lung neuroendocrine tumor. Postoperative chest CT scan confirmed a pulmonary mass consistent with primary neoplasm. Abdominal CT further detected multiple metastases in liver, pancreas, and colon. Despite intensive treatment, the patient continued to show decreased level of consciousness due to cachexia, resulting in death 1 week after surgery. This case highlights the importance of differential diagnosis of invasive lesions of the sellar region, especially in individuals over 60 years of age with diabetes insipidus.
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Affiliation(s)
- Xiaohai Liu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Chinese Pituitary Specialists Congress, Beijing, China
| | - Renzhi Wang
- Chinese Pituitary Specialists Congress, Beijing, China
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Chinese Pituitary Specialists Congress, Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Chinese Pituitary Specialists Congress, Beijing, China
- *Correspondence: Ge Chen,
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23
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Pituitary metastasis of a breast ductal adenocarcinoma. Ann Med Surg (Lond) 2020; 60:380-383. [PMID: 33235712 PMCID: PMC7672244 DOI: 10.1016/j.amsu.2020.10.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022] Open
Abstract
Pituitary metastases are rare, a primary tumor of the breasts or lungs are frequently found. The clinical picture is very variable, they can be accidental discovery or revealed by a pituitary dysfunction. The prognosis is generally poor and depends on the anatomopathological type. We report the observation of a patient with a pituitary metastasis of a breast cancer evolving for 4 years, the diagnosis was suspected in front of pituitary macroadenoma images, a transphenoidal endoscopic biopsy and an anatomopathological confirmation revealing an infiltrating breast adenocarcinoma. Pituitary metastases are rare, a primary tumor of the breasts or lungs are frequently found. The prognosis of the pituitary metastases is generally poor and depends on the anatomopathological type. The clinical picture of the pituitary metastases is very variable, they can be accidental discovery or revealed by a pituitary dysfunction.
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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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Pituitary metastasis of malignant melanoma misdiagnosed as pituitary adenoma: A case report and systematic review of the literature. Neurochirurgie 2020; 66:383-390. [PMID: 32777231 DOI: 10.1016/j.neuchi.2020.06.129] [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] [Received: 04/01/2020] [Revised: 05/17/2020] [Accepted: 06/13/2020] [Indexed: 11/21/2022]
Abstract
We report a case of malignant melanoma revealed by a metastasis to the pituitary gland. The tumor was misdiagnosed as a pituitary adenoma and aggressive transsphenoidal surgery was complicated by a cerebrospinal fluid fistula. Nine weeks later, the patient presented multiple leptomeningeal and brain metastases spreading from the sellar region. Regarding these observations, we conducted a systematic review of the literature in order to investigate clinicoradiological features that should lead clinicians to suspect pituitary metastasis and how it should impact the surgical management.
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Yao H, Rui W, Zhang Y, Liu Y, Lin S, Tang H, Zhao W, Wu Z. Prolactin-Secreting Lung Adenocarcinoma Metastatic to the Pituitary Mimicking a Prolactinoma: A Case Report. Neurosurgery 2020; 85:E773-E778. [PMID: 30137505 DOI: 10.1093/neuros/nyy386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/22/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Metastasis to the pituitary gland is uncommon in patients with systemic disseminated cancer. Individual articles have reported cases of pituitary metastasis mimicking a prolactinoma, but no case of a prolactin-secreting tumor metastasizing to the pituitary mimicking a prolactinoma has been reported so far. CLINICAL PRESENTATION This article reports a 67-yr-old man with a recent onset of headaches, ophthalmoplegia, hypopituitarism, and hyperprolactinemia who was initially diagnosed with prolactinoma and given bromocriptine in the local hospital. Because of vomiting after taking drugs, he was transferred to our hospital for further diagnosis and treatment. Serum prolactin was elevated up to 1022 ng/mL, and pituitary magnetic resonance imaging revealed a 2.9 × 2.8 × 2.3 cm sellar mass with pituitary apoplexy, for which endoscopic transsphenoidal surgery was performed. Postoperative pathology and western blotting disclosed a prolactin-positive metastatic lung adenocarcinoma. Whole exome sequencing revealed a number of gene mutations including KRAS, PIK3CA, ALK, and CTNNB1. The patient died of deterioration of the lung disease 3 mo after the initial diagnosis. CONCLUSION To the best of our knowledge, this is the first report of a prolactin-secreting tumor metastasizing to the pituitary mimicking a prolactinoma as confirmed by both immunohistochemistry and western blot. Prolactin secretion is rare and elusive, and may associate with specified gene mutations.
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Affiliation(s)
- Hong Yao
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Rui
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Zhang
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yanting Liu
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shaojian Lin
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Tang
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiguo Zhao
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhebao Wu
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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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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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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Mormando M, Puliani G, Barnabei A, Lauretta R, Bianchini M, Chiefari A, Russillo M, Cognetti F, Romano L, Appetecchia M. A Rare Case of Pituitary Melanoma Metastasis: A Dramatic and Prolonged Response to Dabrafenib-Trametinib Therapy. Front Endocrinol (Lausanne) 2020; 11:471. [PMID: 32793120 PMCID: PMC7390838 DOI: 10.3389/fendo.2020.00471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/15/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction: Pituitary metastases (PM) are rare events and to date only very few cases of melanoma PM have been described in literature up to now. Case Presentation: We describe the clinical history of a 33-year-old male patient who underwent surgical excision of an inter-scapular melanoma in 2008. The subsequent follow-up was negative for ~10 years. In September 2018, due to the onset of a severe headache, the patient underwent a brain magnetic resonance imaging, which showed an expansive mass in the saddle and suprasellar region with a maximum diameter of 17 mm. Pituitary function tests and visual field were normal. Worsening of the headache and the appearance of a left eye ptosis led the patient to surgical removal of the lesion in October 2018. The histological examination unexpectedly showed metastasis of the melanoma. Post-operative hormonal assessment showed secondary hypothyroidism and hypoadrenalism, which were both promptly treated, and a mild hypogonadism. Three months after surgery, a sellar MRI showed a persistent, increased pituitary mass (3 cm of diameter); fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) detected an increased radiopharmaceutical uptake in the sellar region. Due to the persistence of the disease and the evidence of a BRAF V600E mutation, in February 2019, the patient underwent a combined treatment with dabrafenib (a BRAF inhibitor) and trametinib (mitogen-activated extracellular signal-regulate kinase inhibitor). Sellar MRI performed 6 months later showed no evidence of mass in the sellar region. The patient was in a good clinical condition and did not complain of headaches or other symptoms; there were no significant side-effects from the anticancer therapy. After 13 months of treatment, the patient showed no recurrence of the disease on morphological imaging. Anticancer therapy was confirmed, replacement therapies with hydrocortisone and levothyroxine continued and the pituitary-gonadal axis was restored. Conclusion: This is a very interesting case, both for the rarity of the pituitary melanoma metastasis and for the singular therapeutic course carried out by the patient. This is the first case of a pituitary melanoma metastasis with BRAF mutation, successfully treated with the combination of dabrafenib and trametinib after incomplete surgical removal.
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Affiliation(s)
- Marilda Mormando
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Puliani
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Agnese Barnabei
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Rosa Lauretta
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marta Bianchini
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alfonsina Chiefari
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Michelangelo Russillo
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Cognetti
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Luisa Romano
- Nuclear Medicine Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marialuisa Appetecchia
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Marialuisa Appetecchia
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Abstract
The pituitary fossa is an uncommon site for metastatic tumor spread. Metastatic lesions to the sellar area derived mostly from breast, lung, renal, prostate, and colon cancers, and rarely from other solid and hematologic malignancies. Almost every cancer has been reported as a source of pituitary metastasis. Pituitary metastasis can involve both the anterior and posterior lobes, but the neuro-hypophysis is mainly involved. Clinical manifestations include diabetes insipidus, hypopituitarism, headache, visual disturbances, ophthalmoplegia, and also compression of adjacent structures by aggressive tumor masses. Metastatic spread to the pituitary from a distant primary malignancy is commonly associated with metastases to other tissues and poor prognosis, unless efficient systemic targeted medical treatment is available for the primary cancer (melanoma, lymphoma).
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Affiliation(s)
- Ilan Shimon
- Institute of Endocrinology, Beilinson Hospital, Petach Tikva, and Sackler School of Medicine, Tel-Aviv University, Petach Tikva, Israel,
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Patel KR, Zheng J, Tabar V, Cohen MA, Girotra M. Extended Survival After Surgical Resection for Pituitary Metastases: Clinical Features, Management, and Outcomes of Metastatic Disease to the Sella. Oncologist 2019; 25:e789-e797. [PMID: 31784491 DOI: 10.1634/theoncologist.2019-0520] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/18/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients with pituitary metastasis (PM) have a relatively poor prognosis. We describe the presentation, management, and outcomes of patients with PM. SUBJECTS, MATERIALS, AND METHODS We performed a retrospective review of patients diagnosed with PM at a single institution from 1996 to 2015. Eighty-five patients diagnosed with metastasis to the pituitary or sella turcica by pathology or based on a combination of neuroimaging and clinical findings were included. Univariate and multivariable Cox regressions evaluated associations between clinical factors and overall survival. RESULTS The most frequent sites of primary malignancies resulting in PM were lung (26%) and breast (26%). Median age at diagnosis was 60 years (range, 18-95). The most common complaints at diagnosis included visual deficits (62%), headache (47%), and cranial nerve palsy (31%). Seventy percent of patients had pituitary insufficiency-adrenal insufficiency (59%), hypothyroidism (59%), or diabetes insipidus (28%). Management of PM included radiation therapy (76%), chemotherapy (68%), surgical resection (21%), or combination therapy (71%). Fifty percent and 52% of patients who received surgical treatment and irradiation, respectively, reported symptomatic improvement. Median overall survival (OS) was 16.5 months (95% confidence interval: 10.7-25.4). On multivariable analysis, a primary cancer site other than lung or breast (p = .020), age <60 years (p = .030), and surgical resection (p = .016) were associated with longer OS. CONCLUSION Patients <60 years of age, those with primary tumor sites other than lung or breast, and those who undergo surgical resection of the pituitary lesion may have prolonged survival. Surgical resection and radiation treatment resulted in symptomatic improvement in ~50% of patients. IMPLICATIONS FOR PRACTICE This study is the largest original series of patients with metastatic disease to the sella. In patients with pituitary metastasis, younger age, primary site other than lung or breast, and metastatic resection may prolong survival. Resection and radiation led to symptomatic improvement in ∼50% of patients. Seventy percent of patients had hypopituitarism. These hormonal deficiencies can be life threatening and can result in substantial morbidity if left untreated. Patients should be treated using a multimodality approach-including a potential role for surgery, radiation, chemotherapy, and hormone replacement-with the goal of improving survival and quality of life.
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Affiliation(s)
- Krupa R Patel
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Viviane Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Multidisciplinary Pituitary and Skull Base Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc A Cohen
- Multidisciplinary Pituitary and Skull Base Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Monica Girotra
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Multidisciplinary Pituitary and Skull Base Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
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Iglesias P, Cardona J, Díez JJ. The pituitary in nuclear medicine imaging. Eur J Intern Med 2019; 68:6-12. [PMID: 31519379 DOI: 10.1016/j.ejim.2019.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/18/2019] [Accepted: 08/10/2019] [Indexed: 10/26/2022]
Abstract
The pituitary is an endocrine gland with ability to uptake diverse radiopharmaceuticals and, therefore, susceptible to be investigated by nuclear medicine diagnostic procedures. Although this topic has been scarcely scrutinized, we have data indicating that somatostatin receptor scintigraphy with111In-DTPA-D-Phe-octreotide or 99mTc-EDDA/HYNIC-TOC may be of clinical utility in the diagnosis of some pituitary adenomas (PA). Only a few studies have evaluated the diagnostic performance of 99mTc-MIBI and 99mTc (V)-DMSA scintigraphy in pituitary disease. Scintigraphy using 123I-methoxybenzamide (123I-IBZM) might be useful in macroprolactinomas expressing dopamine D2 receptors. Pituitary gland does not usually accumulate 2-deoxy-2-[18F]fluoro-d-glucose (18F-FDG) and, therefore, it is not visualized on positron emission tomography (PET) imaging studies with this radiotracer. The pituitary uptake on18F-FDG PET/CT scans performed in the follow-up of oncological patients are uncommon. However, 60% of these incidental findings are due to PA, mainly non-functioning pituitary macroadenomas, and a small percentage to metastases or other pituitary lesions. Interestingly, 18F-FDG PET/CT may identify hypophysitis induced by different immunotherapeutic agents used in cancer patients. Positive 18F-FDG uptake has been reported in a high percentage of patients with PA, mainly macroadenomas and it seems that there is correlation between tumor size and SUVmax. 68Ga-DOTA-TATE PET/CT may identify functioning and non-functioning PA, although this technique is more useful in the detection of remaining normal pituitary tissue after transsphenoidal adenomectomy, and in the confirmation of recurrence of functioning PA, such as thyrotroph-secreting PA. Furthermore, 68Ga-DOTA-TATE uptake has potential therapeutic implications on molecular-targeted therapy. Lastly, other radiopharmaceuticals that have shown to be taken up in some patients with pituitary disease include 18F-DOPA (prolactinoma), 11C-methionine (residual or recurrent PA), O-(2-18F-fluoroethyl)-l-tyrosine (metastasis), 18F-choline (silent adenoma, ectopic corticotropinoma), and 13N-ammonia (hypopituitarism).
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Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | - Jorge Cardona
- Department of Nuclear Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Juan José Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; Department of Medicine, Universidad Autónoma de Madrid, Spain
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Schill F, Nilsson M, Olsson DS, Ragnarsson O, Berinder K, Edén Engström B, Dahlqvist P, Wahlberg J, Englund E, Burman P. Pituitary Metastases: A Nationwide Study on Current Characteristics With Special Reference to Breast Cancer. J Clin Endocrinol Metab 2019; 104:3379-3388. [PMID: 30892659 DOI: 10.1210/jc.2019-00012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/14/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the contemporary presentation of pituitary metastases. PATIENTS Thirty-eight patients diagnosed with pituitary metastases from 1996 to 2018 in Sweden. METHODS Pituitary metastases were confirmed by histopathology (n = 27) or considered highly likely according to radiological findings, including rapid tumor progression (n = 11). Medical records were reviewed and sellar images reexamined centrally. RESULTS Breast and lung cancers were the most common primary tumors, in 45% and 21% of patients, respectively. Sixty-seven percent of breast cancers overexpressed human epidermal growth factor receptor 2 (HER2); 53% of pituitary metastases from breast cancers appeared ≥10 years after diagnosis of the primary tumor. At presentation, 71% appeared to have ACTH deficiency, 65% had TSH deficiency, and 26% had diabetes insipidus. Fatigue, nausea/vomiting, loss of appetite, weight loss, myalgia, and/or arthralgia were reported in 47% of patients with morning cortisol <100 nmol/L vs 23% with cortisol ≥200 nmol/L. Sixteen patients had visual field defects, and eight had diplopia. Intrasellar and suprasellar tumor growth was the most frequent finding. Initially, a pituitary adenoma was considered the etiology in 18% of patients.Radiotherapy, pituitary surgery, and chemotherapy were used in 68%, 68%, and 11% of patients, respectively. One and 2 years after diagnosis of pituitary metastases, 50% and 26% of patients were alive. CONCLUSION Pituitary metastases may be mistaken for pituitary adenomas and can appear late, especially in breast cancer. Breast cancers overexpressing HER2 seem prone to metastasize to the pituitary. Hypocortisolism may be misdiagnosed as cancer-related malaise. An increased awareness of pituitary metastases and undiagnosed pituitary failure can improve management in these patients.
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Affiliation(s)
- Fredrika Schill
- Department of Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Margareta Nilsson
- Centre for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Daniel S Olsson
- Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Berinder
- Institute of Molecular Medicine and Surgery, Karolinska Institute and Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Britt Edén Engström
- Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University, Uppsala, Sweden
| | - Per Dahlqvist
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jeanette Wahlberg
- Department of Endocrinology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Elisabet Englund
- Department of Genetics and Pathology, Labmedicine, Medical Service, Skåne University Hospital, University of Lund, Lund, Sweden
| | - Pia Burman
- Department of Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden
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Cardona-Rovira MG, Casañ-Fernández R, Sanz-Gallur J, Almonacid-Folch E, Nadal-Máñez A. Pituitary metastasis of solid tumors: 2 cases of different presentation. ACTA ACUST UNITED AC 2019; 66:202-203. [PMID: 30642783 DOI: 10.1016/j.endinu.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/05/2018] [Accepted: 11/11/2018] [Indexed: 10/27/2022]
Affiliation(s)
| | - Rosa Casañ-Fernández
- Unidad de Diabetes y Endocrinología, Servicio de Medicina Interna, Hospital Lluís Alcanyís, Xàtiva, València, España
| | - Javier Sanz-Gallur
- Unidad de Diabetes y Endocrinología, Servicio de Medicina Interna, Hospital Lluís Alcanyís, Xàtiva, València, España
| | - Elena Almonacid-Folch
- Unidad de Diabetes y Endocrinología, Servicio de Medicina Interna, Hospital Lluís Alcanyís, Xàtiva, València, España
| | - Alba Nadal-Máñez
- Hospital Lluís Alcanyís, Xàtiva, Universitat de València, València, España
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Nose K, Ogata T, Tsugawa J, Inoue T, Nabeshima K, Tsuboi Y. Pituitary metastasis of breast cancer mimicking IgG4-related hypophysitis. eNeurologicalSci 2018; 14:13-15. [PMID: 30555944 PMCID: PMC6275161 DOI: 10.1016/j.ensci.2018.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/17/2018] [Indexed: 11/23/2022] Open
Abstract
IgG4-related hypophysitis, which is the pituitary gland inflammation caused by IgG4 positive lymphocytes, can affect cavernous sinus and orbital apex leading to developing cranial nerve related symptoms such as orbital apex syndrome (OAS). Here we report a case of hypopituitarism associated with OAS caused by pituitary metastasis of the breast cancer with elevated serum IgG4 level, who initially resembled to IgG4-related hypophysitis. Although this case had some features in common with igG4-related hypophysitis. The symptoms and pituitary enlargement were typical. However, steroid treatment did not improve her symptoms. Thus, we performed a tissue biopsy. Histopathologic examination of the hypophyseal tumor confirmed metastatic breast cancer in her pituitary. Pituitary metastatic tumor should be suspected if a case with OAS was once diagnosed as a cancer. We experienced the case with pituitary metastatic tumor mimicking IgG4-related hypophysitis. Our case demonstrated orbital apex syndrome associated with high level of serum IgG4 and pituitary gland enlargement. The pathological finding confirmed pituitary metastatic tumor.
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Affiliation(s)
- Kanako Nose
- Department of Neurology, Faculty of Medicine, Fukuoka University, Japan
| | - Toshiyasu Ogata
- Department of Neurology, Faculty of Medicine, Fukuoka University, Japan
| | - Jun Tsugawa
- Department of Neurology, Faculty of Medicine, Fukuoka University, Japan
| | - Tooru Inoue
- Neurosurgery, Faculty of Medicine, Fukuoka University, Japan
| | | | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Japan
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Castle-Kirszbaum M, Goldschlager T, Ho B, Wang YY, King J. Twelve cases of pituitary metastasis: a case series and review of the literature. Pituitary 2018; 21:463-473. [PMID: 29974330 DOI: 10.1007/s11102-018-0899-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The pituitary gland is an unusual site for metastatic spread, but as patients with metastatic malignancy are living longer, it may become more prevalent. Compression of important anatomy adjacent to the sella may produce disabling symptoms and endocrine derangement, leading to significant morbidity. METHODS An ambispective review of patient records between 2013 and 2017 from three neurosurgical centres was performed. After identifying cases, further investigation was performed to evaluate patient demographic, symptoms at presentation, radiological and histological findings, management, and outcome. RESULTS Our investigation identified 12 patients with pituitary metastasis. The average age of the cases was 63.4 years, with breast (n = 4) and lung (n = 4) being the most common primary cancers. In half the cases there was a history of metastatic disease, while in one-quarter of cases, pituitary symptoms were the first sign of malignancy. Adenohypophyseal dysfunction (83%), diabetes insipidus (DI) (75%), headache (67%) and visual field defects (67%) were the most common findings at presentation. Glucocorticoid replacement increased the sensitivity for diagnosis of DI. All cases were contrast enhancing on MRI and the endoscopic trans-sphenoidal approach was preferred for biopsy and debulking. CONCLUSIONS The pituitary should not be overlooked as a site of metastasis and sellar symptoms may be the first presentation of neoplastic disease. Any biochemical or clinical sign of pituitary pathology in a patient with known cancer should raise suspicion for sellar metastasis. Moreover, the development of DI or ophthalmoplegia from any pituitary lesion is suggestive of metastatic disease even in patients with no known primary.
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Affiliation(s)
- Mendel Castle-Kirszbaum
- Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Benjamin Ho
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Yi Yuen Wang
- Department of Neurosurgery, St Vincent's Hospital, Melbourne, Australia
| | - James King
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
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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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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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Mercado M, Melgar V, Salame L, Cuenca D. Clinically non-functioning pituitary adenomas: Pathogenic, diagnostic and therapeutic aspects. ACTA ACUST UNITED AC 2017; 64:384-395. [PMID: 28745610 DOI: 10.1016/j.endinu.2017.05.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/15/2022]
Abstract
Clinically non-functioning pituitary adenomas (NFPAs) are among the most common tumors in the sellar region. These lesions do not cause a hormonal hypersecretion syndrome, and are therefore found incidentally (particularly microadenomas) or diagnosed based on compressive symptoms such as headache and visual field defects, as well as clinical signs of pituitary hormone deficiencies. Immunohistochemically, more than 45% of these adenomas stain for gonadotropins or their subunits and are therefore called gonadotropinomas, while 30% of them show no immunostaining for any hormone and are known as null cell adenomas. The diagnostic approach to NFPAs should include visual field examination, an assessment of the integrity of all anterior pituitary hormone systems, and magnetic resonance imaging of the sellar region to define tumor size and extension. The treatment of choice is transsphenoidal resection of the adenoma, which in many instances cannot be completely accomplished. The recurrence rate after surgery may be up to 30%. Persistent or recurrent adenomas are usually treated with radiation therapy. In a small proportion of these cases, drug treatment with dopamine agonists and, to a lesser extent, somatostatin analogs may achieve reduction or at least stabilization of the tumor.
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Affiliation(s)
- Moises Mercado
- Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional S.XXI, IMSS, Mexico City, Mexico; Neurological Center, American British Cowdray Medical Center, Mexico City, Mexico.
| | - Virgilio Melgar
- Neurological Center, American British Cowdray Medical Center, Mexico City, Mexico
| | - Latife Salame
- Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional S.XXI, IMSS, Mexico City, Mexico
| | - Dalia Cuenca
- Department of Medicine, American British Cowdray Medical Center, Mexico City, Mexico
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40
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Chon H, Yoon K, Kwon DH, Kim CJ, Kim MS, Cho YH. Hypofractionated stereotactic radiosurgery for pituitary metastases. J Neurooncol 2017; 132:127-133. [PMID: 28070828 DOI: 10.1007/s11060-016-2346-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
Abstract
Pituitary metastases (PMs) are uncommon, representing only 1% of pituitary lesions. The diagnosis of PMs can be challenging and an optimal management remains to be determined. Here, we present a pilot clinical study on the efficacy and safety of hypofractionated stereotactic radiosurgery (SRS) with an optimized dosimetric plan in treating PMs. Between June 2013 and December 2014, seven consecutive patients (4 men and 3 women; median age 62 years) had been diagnosed with PMs based on their characteristic clinical and radiological features and subsequently treated using hypofractionated SRS. Primary cancers originated from the lung (n = 5) or the breast (n = 2). All patients presented with diabetes insipidus (DI). Anterior pituitary and visual dysfunction were combined in 4 and 3 patients, respectively. On magnetic resonance imaging (MRI), PMs involved the pituitary stalk and/or the posterior lobe in all patients. SRS of a cumulative marginal dose 31 Gy with dose-volume constraints for the optic apparatus was delivered in 5 daily fractions. As results, tumor was locally controlled in all patients with substantial responses on MRI (including complete remission in 4 patients). The median survival time was 14 months (range, 6-24 months) after SRS. DI and visual dysfunction improved in all patients, although anterior pituitary dysfunction did not recover. No patients experienced any deterioration in visual, pituitary, or other cranial nerve functions. These results suggest a promising role of hypofractionated SRS in treating PMs in terms of both tumor control and functional outcomes.
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Affiliation(s)
- Haemin Chon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - KyoungJun Yoon
- Radiosurgery Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Do Hoon Kwon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.,Radiosurgery Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Chang Jin Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.,Radiosurgery Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Min-Seon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Young Hyun Cho
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. .,Radiosurgery Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Ariizumi H, Sasaki Y, Harada H, Uto Y, Azuma R, Isobe T, Kishimoto K, Shiozawa E, Takimoto M, Ohike N, Mori H. Post-cytokine-release Salt Wasting as Inverse Tumor Lysis Syndrome in a Non-cerebral Natural Killer-cell Neoplasm. Intern Med 2017; 56:1855-1861. [PMID: 28717082 PMCID: PMC5548679 DOI: 10.2169/internalmedicine.56.8125] [Citation(s) in RCA: 2] [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] [Indexed: 12/15/2022] Open
Abstract
The pathogenesis of cerebral/renal salt-wasting syndrome remains unknown. We herein present a case of salt-wasting syndrome with a natural killer-cell neoplasm without cerebral invasion. A 78-year-old man with hemophagocytic syndrome received two cycles of chemotherapy that did not induce tumor lysis syndrome, but repeatedly caused polyuria and natriuresis. The expression of tumor necrosis factor-α in the neoplasm led us to hypothesize that an oncolysis-induced cytokine storm may have caused renal tubular damage and salt wasting. Our theory may explain the pathogenic mechanism of cerebral/renal salt-wasting syndrome associated with other entities, including cerebral disorders, owing to the elevation of cytokine levels after subarachnoid hemorrhage.
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Affiliation(s)
| | - Yosuke Sasaki
- Department of Pathology, Showa University School of Medicine, Japan
| | - Hiroshi Harada
- Department of Hematology, Showa University Fujigaoka Hospital, Japan
| | - Yui Uto
- Department of Hematology, Showa University Fujigaoka Hospital, Japan
| | - Remi Azuma
- Department of Hematology, Showa University Fujigaoka Hospital, Japan
| | - Tomohide Isobe
- Department of Pathology, Showa University Fujigaoka Hospital, Japan
| | - Koji Kishimoto
- Department of Pathology, Showa University Fujigaoka Hospital, Japan
| | - Eisuke Shiozawa
- Department of Pathology, Showa University School of Medicine, Japan
| | | | - Nobuyuki Ohike
- Department of Pathology, Showa University Fujigaoka Hospital, Japan
| | - Hiraku Mori
- Department of Hematology, Showa University Fujigaoka Hospital, Japan
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Zamora C, Castillo M. Sellar and Parasellar Imaging. Neurosurgery 2016; 80:17-38. [DOI: 10.1093/neuros/nyw013] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 10/18/2016] [Indexed: 11/13/2022] Open
Abstract
Abstract
The skull base is a complex anatomical region that harbors many important neurovascular structures in a relatively confined space. The pathology that can develop at this site is varied, and many disease processes may present with similar clinical and neuroimaging findings. While computed tomography maintains a role in the evaluation of many entities and can, for instance, delineate osseous erosion with great detail and characterize calcified tumor matrices, magnetic resonance imaging (MRI) is the mainstay in the neuroimaging assessment of most pathology occurring at the skull base. Various MRI sequences have proven to be robust tools for tissue characterization and can provide information on the presence of lipids, paramagnetic and diamagnetic elements, and tumor cellularity, among others. In addition, currently available MRI techniques are able to generate high spatial resolution images that allow visualization of cranial nerves and their involvement by adjacent pathology. The information obtained from such examinations may aid in the distinction of these disease processes and in the accurate delineation of their extent prior to biopsy or treatment planning.
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