Cushing’s disease due to a pituitary adenoma as a component of collision tumor: A case report and review of the literature

Abstract

Background: The coexistence of two morphologically different tumors attached to each other creates a very rare type of tumor called a collision tumor. Collision tumors containing pituitary adenoma-sellar meningioma have only been described in four cases to date; we discuss a fifth case harboring a collision tumor comprising a pituitary corticotroph adenoma and a sellar meningioma in the same anatomic position. Case presentation: A 34-year-old Caucasian woman presented with menstrual irregularity, severe weakness of the proximal muscles, and 10-15 kg weight gain within a year. Basal plasma cortisol and adrenocorticotrophic hormone levels were 17.7 mg/dL and 58 pg/mL, respectively. Her diurnal cortisol rhythm was impaired (plasma cortisol at 23: 00, 18.2 mg/dL) and after a 48-hour, 2-mg dexamethasone suppression test, plasma cortisol level was 13.6 mg/dL. The results were consistent with a diagnosis of Cushing's syndrome. We then performed a nocturnal 8-mg dexamethasone suppression test and the suppression of cortisol was not greater than 50% (21.4 to 19.3). A pituitary magnetic resonance imaging revealed a tuberculum sellae meningioma arising from within the sellar region. An operation was chosen in order to examine whether the tumor was an adrenocorticotrophic hormone/corticotropinreleasing hormone-secreting lesion or if there were any microadenomas that could be observed during the operation. Via an extended endoscopic endonasal approach the meningioma was resected successfully. Unexpectedly, our patient complained of nausea and vomiting postoperatively. Plasma cortisol was 2.6 mg/dL and orally administered hydrocortisone treatment was initiated immediately. Histopathological examination revealed that the tumor generally consisted of a pituitary corticotroph adenoma infiltrated by meningioma. Our patient maintained hydrocortisone treatment for 11 months. At the latest visit, she had lost 12 kg, and her hypertension, menstrual irregularity, and weakness of the proximal muscles had disappeared. Her mental and physical wellbeing were restored.

Collision Tumor Composed of Nonfunctioning Pituitary Adenoma and Meningioma in the Sellar Region: Report of a Case and Literature Review

“…4 A "collision tumor" represents two histologically distinct primary neoplasms occurring in the same anatomic position with a shared border. 5 The concurrent occurrence of collision tumor involving ganglioglioma and ependymoma and glioblastoma and meningioma have been reported. 6,7 Collision tumor involving meningioma and pituitary adenoma in the sellar region is extremely uncommon.…”

Coexisting Non-functioning Pituitary Macroadenoma and Sellar-Suprasellar Lipoma: A Case Report and Literature Review

“…Growth hormone secretion may induce meningioma growth. 15 58/F 1.12 x 0.54 x 1.07 cm short signal on T1W and T2W imaging with low signal surrounding a high signal on T2W 16 34/F 1.2 x 0.75 cm solid well-defined mass in the anterior part of the pituitary with an enhancing mass with a dural tail within the sellar region…”

“…6,7 Unfortunately, the pathogenesis is still poorly understood but may be weakly attributed to common genetic linkages. 6 Even more infrequent is the coincidence of a functioning or nonfunctioning pituitary adenoma with another distinct tumor particularly in the sellar-suprasellar area, such as lymphoma 7 , craniopharyngioma [8][9][10] , meningioma [11][12][13][14][15][16] , schwannomas and gangliocytomas 16 , Rathke's cleft cyst 16 , and chondroma 16 . To the authors' knowledge, we have not encountered any published literature reporting the coexistence of a histopathology-confirmed pituitary adenoma and sellarsuprasellar lipoma.…”

Automatic detection of pituitary microadenoma from magnetic resonance imaging using deep learning algorithms

“…At screening, patients underwent a comprehensive physical examination, pituitary MRI and fasting blood sampling for biological measurements, including HbA1c which was measured by D-10 hemoglobin Testing Program suppression test and the suppression of cortisol greater than 50% basal cortisol level was considered a positive result) [33][34][35] . For this study, 6 positive and false negative patients undergoing transsphenoidal resection of the pituitary microadenoma were included (Fig 6).…”

“…For this study, 6 positive and false negative patients undergoing transsphenoidal resection of the pituitary microadenoma were included (Fig 6). After the surgical operation, the tumor tissues from patients were used for hematoxylin and eosin (HE) staining as well as immunohistochemistry (ACTH, GH, FSH, PRL, TSH, LH) staining to determine the type of pituitary microadenoma [29,34] .…”