Intracranial metastatic disease rarely involves the pituitary: retrospective analysis of 935 metastases in 155 patients and review of the literature

Marsh, J. W.; Garg, Shalini; Wendt, Julie; Gielda, Benjamin T.; Turian, J; Herskovic, Arnold

doi:10.1007/s11102-010-0229-4

Cited by 22 publications

(13 citation statements)

References 57 publications

(174 reference statements)

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“…At present, it is reported that following autopsy, pituitary lesions account for 0.14-28.1% of all brain metastases (3,6,9). Despite this, clinical detection and management of the lesions remain complex and ambiguous.…”

Section: Discussionmentioning

confidence: 99%

“…Despite this, pituitary metastases are seldom diagnosed and rarely described in surgical series, overall representing just 1% of surgically-resected tumours in the sellar region (5). The clinical differential diagnosis of benign lesions in the sellar region is challenging, and at present, a definitive clinical criteria is not available (6). The majority of patients may be asymptomatic, but the most common symptoms include central diabetes insipidus, anterior hypopituitarism, visual loss and central nervous system disorders (7).…”

Section: Introductionmentioning

confidence: 99%

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Pituitary lesions in breast cancer patients: A report of three cases

et al. 2015

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Abstract.Pituitary metastases occur in 6-8% of breast cancer cases, but are seldom diagnosed and rarely reported. Therefore, it can be challenging to establish a clinical differential diagnosis, and at present, a definitive criteria is not available. The present study discusses the pituitary lesions identified in three patients with breast cancer, and describes their management within the collaborative framework of the Breast Unit at the Città della Salute Hospital, which also included assessment by endocrinologists. The patients were evaluated for anterior and posterior pituitary function, the appearance of the pituitary upon magnetic resonance imaging (MRI), and the oncology status and treatment. In addition, successive analysis of prolactin levels and the MRI was performed. The patients, aged 75, 83 and 76 years old, differed in their clinical presentation and successive evolution. One patient demonstrated an abrupt onset of diabetes insipidus, the second exhibited overt hypopituitarism and the final patient had a pituitary mass discovered by chance. Cases one and three exhibited systemic spread of the breast cancer, with bone and/or parenchymal metastasis, but not brain metastasis. Case two presented with a secondary pituitary tumour alone. In case three, a secondary nature to the pituitary lesion was unlikely, since there was no lesion evolution evident following MRI and as stable prolactin levels were observed over the course of the study period. By contrast, case one presented with a rapid increase of sellar lesions on MRI, together with a progressive rise in prolactin levels. Taking into account the frailty of breast cancer patients who are monitored for disease progression, management in a collaborative framework, such as at the Breast Unit, makes it possible to establish a diagnosis of sellar lesions, which is adequate for the comprehensive management of the patient with successive pituitary MRIs and prolactin evaluations, and avoids unnecessary invasive neurosurgery. IntroductionIn breast cancer patients, the development of metastatic disease is considered to be the major cause of mortality (1). The invasion-metastasis cascade is a multistep process in which breast cancer cells invade the systemic circulation and distant tissues, and cause the metastatic colonization of different organs, including the bones, lungs and central nervous system (2). Being highly vascularized, the pituitary gland is a target structure for metastatic spread, accounting for 0.14-28% of all reported brain metastases following autopsy (3). In total, 6-8% of breast cancer cases demonstrate metastatic spread to the pituitary gland (4). Despite this, pituitary metastases are seldom diagnosed and rarely described in surgical series, overall representing just 1% of surgically-resected tumours in the sellar region (5). The clinical differential diagnosis of benign lesions in the sellar region is challenging, and at present, a definitive clinical criteria is not available (6). The majority of patients may be asymptomatic, but the mos...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pituitary lesions in breast cancer patients: A report of three cases

et al. 2015

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“…20% of patients diagnosed with DI may present pituitary metastases (15). However, the clinical presentation is variable (16), and may be associated with ophthalmoplegia, headache, visual field abnormalities and anterior pituitary dysfunction (5), and could also present with seizures, paralysis of III and IV cranial pairs and hyperprolactinemia.…”

Section: Discussionmentioning

confidence: 99%

Breast cancer metastasis to the pituitary gland

Magalhães

Bacchin

Costa

et al. 2014

Arq Bras Endocrinol Metab

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SUMMARYMetastatic tumors to the pituitary gland are an unusual complication typically seen in elderly patients with diffuse malignant disease. Breast and lung are the commonest sites of the primary tumor. Prognosis of patients with breast cancer metastasis is poor and depends on the primary neoplastic extension. We report a 54 year-old woman with breast cancer metastasis to the pituitary stalk first diagnosed because of visual disturbance with no other symptoms. Pituitary gland stalk metastasis is a very uncommon find and this case report includes a literature review. SUMÁRIOOs tumores hipofisários malignos são raros e geralmente se constituem de metástases de neoplasias disseminadas. Câncer de mama e pulmão são os sítios primários mais frequentes e o prognóstico depende do grau de comprometimento da doença. Este é o relato do caso de uma mulher de 54 anos que apresentou uma lesão tumoral restrita à haste hipofisária, que se revelou como metástase do câncer de mama previamente conhecido. O acometimento da haste hipofisária é muito raro, motivo pelo qual descrevemos o caso com a revisão da literatura específica.Arq Bras Endocrinol Metab. 2014;58(8):869-72

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“…There have been few reports of pituitary metastases in the literature. James et al found no cases of pituitary gland or sellar metastasis in their cross sectional, retrospective analysis of neuro-imaging (CT and MRI) of 155 patients diagnosed with intracranial metastatic disease 1. In 1857, L Benjamin first described a case of metastasis to the pituitary gland in an autopsy of a patient with disseminated melanoma 2.…”

Section: Discussionmentioning

confidence: 99%

“…Previous literature reviews have suggested that it may be possible to distinguish pituitary adenomas from pituitary metastases on clinical grounds, but radiographic findings are not helpful in this regard 1 6. This was highlighted in our case as the initial radiological diagnosis was that of a pituitary adenoma.…”

Section: Discussionmentioning

confidence: 99%

A rare ophthalmic presentation of pituitary metastases

Mansoor

Carey²,

Adams³

2012

Case Reports

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BACKGROUNDPituitary metastases are very rare and the most common clinical presentation with a pituitary metastasis is diabetes insipidus, which may be the fi rst manifestation of the underlying tumour. We present a case who presented with an ophthalmoplegia, headache and reduced vision and later on diagnosed with pituitary metastases. CASE PRESENTATIONAn 83-year-old woman presented to the eye casualty department with a history of progressive horizontal diplopia, fronto-occipital headache and reduced vision in her right eye over a period of 1 month. On examination, she had complete right ptosis with partial oculomotor nerve paralysis with pupil involved. Best corrected visual acuity was 6/18 right and 6/6 left eye, respectively. Confrontational visual fi eld analysis showed no absolute scotoma and the optic discs and retinae were normal. Systemic examination was unremarkable and there was no lymphadenopathy. She reported being a smoker of 10 cigarettes per day over last several decades. Her bloods tests showed an elevated erythrocyte sedimentation rate (ESR) of 82 mm/h with C reactive protein (CRP) of 115 mg/l. There were no associated symptoms of jaw claudication or weight loss. Her white cell count was 18.41×109/l. The initial working diagnosis was that of giant cell arteritis and a temporal artery biopsy was organised but in view of the ophthalmoplegia we arranged an urgent MRI scan of head. The patient was started on 40 mg/day of oral prednisolone at this point and she also had an urgent chest x-ray. INVESTIGATIONSThe temporal artery biopsy was negative. Chest x-ray showed mild heart enlargement with a perihilar shadowing on right side. Head MRI scan showed a large pituitary tumour with suprasellar extension involving the right cavernous sinus and superiorly the optic chiasm on the right was compressed ( fi gure 1 ). There was homogenous enhancement with intravenous gadolinium indicating a likely pituitary macroadenoma ( fi gure 2 ).Due to the consolidation in the right lung we arranged urgent CT scan of the thorax. This showed a 2.5 cm soft tissue mass in the right perihilar region with deeper infi ltration causing a partial collapse of the middle lobe. It was thought that this was consistent with central bronchial tumour ( fi gure 3 ). Bronchoscopy was unfortunately not diagnostic. Further haematological and radiological investigations did not show any secondaries. OUTCOME AND FOLLOW-UPSubsequent transphenoidal debulking of the pituitary yielded histology showing a metastatic adenocarcinoma of primary lung origin. DISCUSSIONMetastasis to the pituitary gland is very uncommon and a fi rst presentation of any systemic tumour through pituitary metastasis is rare. There have been few reports of pituitary metastases in the literature. James et al found no cases of pituitary gland or sellar metastasis in their cross sectional, retrospective analysis of neuro-imaging (CT and MRI) of 155 patients diagnosed with intracranial metastatic disease. 1 In 1857, L Benjamin fi rst described a case of metastasis to the pituit...

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Intracranial metastatic disease rarely involves the pituitary: retrospective analysis of 935 metastases in 155 patients and review of the literature

Cited by 22 publications

References 57 publications

Pituitary lesions in breast cancer patients: A report of three cases

Pituitary lesions in breast cancer patients: A report of three cases

Breast cancer metastasis to the pituitary gland

A rare ophthalmic presentation of pituitary metastases

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