Metastatic Pituitary Tumor From Renal Cell Carcinoma Treated by Fractionated Stereotactic Radiotherapy-Case Report-

Abstract

A 63-year-old man presented with rapidly progressive visual field deficit and hypopituitarism including diabetes insipidus, 8 years after treatment for a renal cell carcinoma. Neuroimaging studies revealed a dumbbell-shaped pituitary mass that had destroyed the sellar floor and abutted against the optic apparatus. Fractionated stereotactic radiotherapy (SRT), employing computer-image integration techniques and a frame that could be relocated to facilitate a fractionated dosing scheme, was carried out under a plan for reducing the treatment risk to the optic apparatus. Three months later, the patient exhibited marked improvement in the visual field deficit and visual acuity concomitant with a reduction in tumor volume. Magnetic resonance imaging of the sellar region confirmed striking shrinkage of the metastasis. His neurological status remained stable at 12 months after the SRT with no complications. Fractionated SRT appears to be effective for preserving or improving the residual vision in patients with visual loss secondary to metastatic tumor of the pituitary gland, and may result in a longer and better quality of life.

Symptomatic pituitary metastases from renal cell carcinoma

“…Other less common primary tumors associated with pituitary metastasis include gastrointestinal tract (6.3%), prostate (5%), melanoma (2.4%) and thyroid (2.2%) malignancies [1]. Symptomatic MP from RCC is extremely uncommon, with only 19 cases reported in the literature [4,7,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Metastatic tumor cells may reach the sella via several routes: (1) direct hematogenous spread; (2) spread from a hypothalamic or stalk metastasis through the portal hypophyseal vessels; (3) extension from juxtasellar and skull base metastasis; or, (4) meningeal spread through the suprasellar cistern [9].…”

Isolated pituitary metastasis from renal cell carcinoma in a horseshoe kidney

“…Operative case series have not found any significant survival benefits from tumor resection, though the patient's quality of life may be improved. [3,14] Radiotherapy can be given as fractionated, external radiation or stereotactic radio-surgery. Radiotherapy can be used as primary therapy in patients who are not candidates for surgery or as an adjuvant therapy after trans-sphenoidal surgery.…”

“…Radiotherapy can be used as primary therapy in patients who are not candidates for surgery or as an adjuvant therapy after trans-sphenoidal surgery. [14] The usefulness of chemotherapeutic agents varies by primary tumor type. Thyroxine kinase inhibitors (Sorafenib and sunitinib) have been reported to use as palliative therapy to control the growth of RCC metastases in a few cases.…”

Pituitary gland metastases from renal cell carcinoma: A case report and literature update

“…Symptomatic pituitary metastasis of renal cell carcinoma is very rare and only 25 cases have been described [1][2][3][4][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Only 7% of pituitary metastases are symptomatic [13,19,22].…”

“…Any malignant tumour can metastasize to the pituitary gland, but breast and lung cancer are the most prevalent, accounting for two thirds of the cases [1][2][3]. McCormik described a surgical series of 780 cases of transsphenoidal surgery with only six cases (0,8%) of pituitary secondary lesions [4].…”