Cytomorphology of metastatic pituitary carcinoma to the bone

Abstract

Metastatic pituitary carcinoma to bone is rare. In this report, we present a case of a 59-year-old female with recurrent pituitary adenoma of the sparsely granulated somatotroph subtype with metastasis to a few bony sites 10 years later. Needle core biopsy (NCB) with touch preparations was performed on a 5 mm lesion in left ilium. Diff-Quik stained NCB touch preparation slides showed a few loosely cohesive epithelial polygonal cells that were arranged in nests or acini, or singly, had scant vacuolated cytoplasm and eccentrically located round nuclei (plasmacytoid) with slight nuclear pleomorphism, fine granular chromatin, conspicuous nucleoli, and smooth nuclear membrane. Trilineage hematopoietic cells of bone marrow were also appreciated in the background. H&E stained core sections showed fragments of bone and bone marrow with nests of bland epithelial cells with similar cytomorphology as seen in NCB touch preparation slides. The tumor cells were immunoreactive for juxtanuclear dot-like staining of pan-cytokeratin (CAM 5.2 and AE1/AE3) (a specific feature), neuroendocrine markers (CD56, synaptophysin, and chromogranin. Additionally, scattered cells were immunoreactive for growth hormone. Molecular test showed that tumor cells were negative for the promoter methylation of O-6-Methylguanine-DNA Methyltransferase (MGMT). Final diagnosis of metastatic pituitary carcinoma was rendered. Morphology of metastatic pituitary carcinoma, its differential, clinical presentation and treatment were discussed. Diagn. Cytopathol. 2017;45:645-650. © 2017 Wiley Periodicals, Inc.

Temozolomide and Capecitabine Treatment for an Aggressive Somatotroph Pituitary Tumor: A Case Report and Literature Review

“…We meticulously reviewed all published reports and our own experiences of no less than 1500 somatotroph tumors. There have been 11 cases, including our two, describing both TMZ treatment outcomes and the degree of MGMT expression, in aggressive or malignant somatotroph tumors; the summary of these cases is shown in Table 1 ( 9 , 10 , 19 – 22 ). Several previous studies showed the correlation between MGMT promoter methylation and protein expressions in IHC ( 23 , 24 ), and it is thought that unmethylated MGMT promotor most leads to strong expressions in IHC ( 23 , 24 ).…”

“…Several previous studies showed the correlation between MGMT promoter methylation and protein expressions in IHC ( 23 , 24 ), and it is thought that unmethylated MGMT promotor most leads to strong expressions in IHC ( 23 , 24 ). Two cases which analyzed the promoter methylation status reported unmethylated MGMT promoters ( 20 , 22 ); and nine cases reported strong expression of MGMT. This is in direct contrast to aggressive corticotroph tumors which are usually weakly positive or negative in MGMT IHC according to our own experiences and the available literature ( 25 , 26 ).…”

Cytomorphology of pituitary carcinoma metastatic to liver diagnosed by fine-needle aspiration: A rare case report and review of literature

“…However, the presence of perinuclear hof/clearing, Russell bodies, clock-face chromatin, and Dutcher bodies may help in distinguishing the two entities on FNA. [ 8 ] In the presence of loose clusters and microacini along with epithelioid morphology, metastatic adenocarcinoma may also be considered in the differentials, particularly of lung or breast origin. However, the absence of marked pleomorphism, rare mitosis, and regular nuclear membrane differentiate PC from metastatic adenocarcinoma.…”