pituitary_carcinoma

Pituitary carcinoma is rare. However, an awareness of this diagnosis is important in patients with previously diagnosed pituitary adenoma who present with neurologic dysfunction or other signs of disseminated malignancy.

Constitutes less than 1% of patients with pituitary tumors 1) 2) 3).

Aggressive pituitary tumors are characterized by invasion of the parasellar region including the cavernous sinus, bone, and subarachnoid space of the suprasellar region. The diagnosis of pituitary carcinoma usually requires evidence of either intracranial or extracranial metastases 4).

Adrenocorticotropin secreting pituitary carcinoma is the most common secretory subtype which undergo malignant transformation 5) 6).

see growth hormone carcinoma.


A 59-year-old male presented with a dural-based posterior fossa lesion. He had been diagnosed with a pituitary chromophobe adenoma 43 years earlier that was treated at the time with surgery and radiation therapy. A presumptive diagnosis of a radiation-induced meningioma was made and surgery was recommended. At surgery the tumour resembled a pituitary adenoma. Histopathology, laboratory findings, and the patient's medical history confirmed the final diagnosis of a prolactin-secreting pituitary carcinoma. To our knowledge, this is the longest reported interval between the pituitary adenoma and metastatic lesion diagnosis (43 years).

CONCLUSION: Management should be tailored to individual patient and may include a combination of treatments (surgery, radiation therapy, chemotherapy, and hormone-targeted therapy). Functionally active tumours may be monitored with hormone levels as tumour markers 7).


1)
Kaltsas GA, Nomikos P, Kontogeorgos G, Buchfelder M, Grossman AB. Clinical review: diagnosis and management of pituitary carcinomas. Journal of Clinical Endocrinology and Metabolism. 2005;90(5):3089–3099.
2)
Ayuk J, Natarajan g, geh Ji, Mitchell rD, Gittoes nJ: Pitui- tary carcinoma with a single metastasis causing cervical spinal cord compression. Case report. J Neurosurg Spine 2: 349–353, 2005
3)
Kaltsas ga, Grossman ab: Malignant pituitary tumours. Pituitary 1: 69–81, 1998
4)
Ono M, Miki N, Amano K, et al. A case of corticotroph carcinoma that caused multiple cranial nerve palsies, destructive petrosal bone invasion, and liver metastasis. Endocrine Pathology. 2011;22(1):10–17.
5)
Dillard TH, Gultekin SH, Delashaw JB, Jr., Yedinak CG, Neuwelt EA, Fleseriu M. Temozolomide for corticotroph pituitary adenomas refractory to standard therapy. Pituitary. 2011;14(1):80–91.
6)
van der Klaauw AA, Kienitz T, Strasburger CJ, Smit JWA, Romijn JA. Malignant pituitary corticotroph adenomas: report of two cases and a comprehensive review of the literature. Pituitary. 2009;12(1):57–69.
7)
Todeschini AB, Beer-Furlan A, Montaser AS, Jamshidi AO, Ghalib L, Chavez JA, Lehman N, Prevedello DM. Pituitary carcinomas: review of the current literature and report of atypical case. Br J Neurosurg. 2019 Mar 5:1-6. doi: 10.1080/02688697.2019.1582750. [Epub ahead of print] PubMed PMID: 30836020.
  • pituitary_carcinoma.txt
  • Last modified: 2019/04/01 12:05
  • by administrador