PNA Medical Corner: Pituitary Carcinoma
This 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.
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]
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.
Pituitary carcinomas are poorly understood, rare entities. They are distinguished from adenomas not by histopathological features but rather by the presence of metastases.
We discuss the diagnosis, mechanism of dissemination and pathogenesis based on a review of the literature and illustrated by a singular case.
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).
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.
Pituitary Diseases; endocrinology; neurosurgery; pituitary carcinoma; prolactinoma
PMID:30836020 DOI: 10.1080/02688697.2019.1582750