PNA Medical Corner: Pituitary Carcinoma

Dr. Prevedello pictureLuma GhalibThis month the PNA Medical Corner features a study co-authored by Dr. Daniel Prevedello, a member of the PNA board of directors and Dr. Luma Ghalib a PNA member. The study reviews the relevant studies and then discusses the case of a man who had surgery for a pituitary tumor and then 43 years later was diagnosed with a meningioma. But the second tumor was revealed to be a prolactin-secreting pituitary adenoma.

Abstract:

Pituitary carcinomas: review of the current literature and report of atypical case.
Todeschini AB1, Beer-Furlan A1, Montaser AS1,2, Jamshidi AO1, Ghalib L3, Chavez JA4, Lehman N4, Prevedello DM1,5.
Br J Neurosurg. 2019 Mar 5:1-6. doi: 10.1080/02688697.2019.1582750. [Epub ahead of print]

Author Information

1 Department of Neurological Surgery, Wexner Medical Center , The Ohio State University College of Medicine , Columbus , OH , USA.
2 Department of Neurological Surgery , Ain Shams University , Cairo , Egypt.
3 Department of Internal Medicine - Division of Endocrinology, Diabetes and Metabolism, Wexner Medical Center , The Ohio State University College of Medicine , Columbus , OH , USA.
4 Department of Pathology, Wexner Medical Center , The Ohio State University College of Medicine , Columbus , OH , USA.
5 Department of Otolaryngology - Head and Neck Surgery, Wexner Medical Center , The Ohio State University College of Medicine , Columbus , OH , USA.

INTRODUCTION:

Pituitary carcinomas are poorly understood, rare entities. They are distinguished from adenomas not by histopathological features but rather by the presence of metastases.

OBJECTIVE:

We discuss the diagnosis, mechanism of dissemination and pathogenesis based on a review of the literature and illustrated by a singular case.

CASE REPORT:

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.

KEYWORDS:

Pituitary Diseases; endocrinology; neurosurgery; pituitary carcinoma; prolactinoma
PMID:30836020 DOI: 10.1080/02688697.2019.1582750

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