A case report of sarcoma of the sella caused by postoperative radiotherapy for a prolactin-producing pituitary adenoma

Abstract

We report a case of sarcomatous transformation of a prolactin (PRL)-producing pituitary adenoma in a 27-year-old man. He originally presented with bitemporal visual disturbance, headache, and hyperprolactinemia 8 years earlier. Tumor shrinkage was confirmed by magnetic resonance imaging (MRI) during treatment with dopamine-receptor agonist. However, 3 years later transsphenoidal surgery had to be performed because of tumor re-growth. Histopathological examination revealed a PRL-producing adenoma with fibrotic changes. One year later, he presented with right-sided visual disturbance, and tumor re-growth was confirmed using MRI. He underwent transcranial surgery, followed by radiation therapy (50 Gy in 25 fractions). The histological and immunostaining features were similar in both specimens obtained from the two operations. Four years later, he presented with left-sided visual disturbance, and tumor re-growth was confirmed using MRI. The mass lesion dramatically increased in size within 2 months, and partial removal of the tumor by craniotomy was performed. The specimen was histologically diagnosed as malignant fibrous histiocytoma (MFH). Regardless of aggressive chemotherapy, his clinical symptoms and imaging findings worsened rapidly. He died 7 months after the diagnosis of MFH. Because patients with pituitary tumor undergoing radiotherapy face the possibility of developing such neoplasm, long-term follow-up is required.

Extended transsphenoidal approach for pituitary adenomas invading the cavernous sinus using multiple complementary techniques

“…The major disadvantage of medical therapy, such as long-lasting somatostatin analogs for patients with acromegaly, is its noncurative nature; patients require life-long treatment, resulting in high costs and long-term side effects. Radiotherapy also has disadvantages, including visual deterioration, panhypopituitarism, and sarcomatous transformation [5,6]. Therefore, gross-total resection (GTR) is the primary goal for most patients with pituitary adenomas invading the CS, especially those with functional adenomas.…”

Broad clinical spectrum and diverse outcomes of prolactinoma with pediatric onset: medication-resistant and recurrent cases

“…Especially, Subject 1 showed unusual malignant transformation and uncontrolled hyperprolactinemia despite high dose of BRC or CBG. Although the neck radiotherapy seemed to be effective to suppress hyperprolactinemia and shrink the tumor size, previous radiotherapy might affect the malignant change and natural course of prolactinoma [28].…”

Intracranial Pleomorphic Malignant Fibrous Histiocytoma, Associated to Systemic Lupus Erythematous: A Case Report

“…Most of the MFH reported in the literature affected pediatric cases, less than 24 months of age [4][5][6][7][8][9][10][11][12][13][14][15][16]. Radical excision of intracranial FHT, provided it is technically feasible, is considered the optimum therapy for a satisfactory outcome.…”

“…Radical excision of intracranial FHT, provided it is technically feasible, is considered the optimum therapy for a satisfactory outcome. However, have been suggested the role of adjunctive radiation and chemotherapy in the subsets that invade bone [11][12][13][14][15][16][17]. Furthermore, the current case was offered radical excision only.…”

“…MFH are rare intracranial tumors, they usually presented as a meningeal mass, intraaxially [5][6][7][8], mesenchymal [9], or and intraventricular location [10]. Some cases have been associated to radiotherapy [11][12][13][14][15][16][17]. Radiation-associated status and incomplete resection has been identified as independent predictors of local recurrence.…”