Pituitary Adenoma as an Unsuspected Clival Tumor

Clival Invasion on Multi-Detector CT in 390 Pituitary Macroadenomas: Correlation with Sex, Subtype and Rates of Operative Complication and Recurrence

“…The few reports published to date have not reported series of sufficient size to establish the characteristic clinical, pathologic, and imaging attributes of clival invasion by pituitary adenoma. [6][7][8][9] In our study population, most patients with macroadenoma presented in the fourth and fifth decades of life; the frequency and size of macroadenoma were nearly equal in men (53.33% of cases; 5.92 Ϯ 7.63 cm 3 ) and women (46.67%; 5.73 Ϯ 7.22 cm 3 ); the proportion of null-cell pituitary macroadenoma was 36.4% (142/390). These population statistics are similar to previous reports, [10][11][12][13] suggesting that this sample, though retrospective, may be a relatively good representation of the general population of patients with adenoma.…”

“…This implies that further study of therapeutic technique may be warranted in this patient group. Although invasion of pituitary tumors into the clivus has been described, [9][10][11][12][13][14][15][16][17][18] mostly in the form of case reports, 7,8,19 to our knowledge, this is the first study designed to systematically define the clinical and histologic correlates of clival invasion on CT in a large patient cohort.…”

Ectopic macroprolactinoma mimicking a chordoma: a case report.

“…Intracranial locations consist of the suprasellar region, the clivus (as in our patient), parasellar and in the sella turcica, but outside the pituitary capsule. Only eight ectopic pituitary adenomas at the clivus have previously been described in publications (Ortiz-Suarez & Erickson 1975, Shenker et al 1986, Anand et al 1993, Mount et al 1993, Arnesen & Scheithauer 1994, Kikuchi et al 1994, Wong et al 1995. There were three different hormonal diagnoses: one of Cushing's disease, three of non-functional adenomas and four of prolact-inomas.…”

“…In the case of an isolated mass at the clivus, the following differential diagnoses are considered: chordoma, non-Hodgkin lymphoma, metastasis, chondrosarcoma, meningioma, craniopharyngeoma, germinal cell tumour, astrocytoma, and pituitary adenoma (Wong et al 1995). If both a mass at the clivus and an important hyperprolactinaemia are present, an ectopic prolactinoma or the exceedingly rare prolactin-secreting carcinoma are likely.…”

“…A chordoma is the most common of these tumours and represents 40% of all cases. Less common, in decreasing order of frequency, are meningiomas, astrocytoma, germinal cell tumours, lymphoma, metastases and, finally, pituitary adenoma (Wong et al 1995). The last type of tumour is rarely found in this localisation and is called an ectopic pituitary adenoma, as almost all pituitary adenomas are detected in the sella turcica, where they originate from, and in the immediate suprasellar and parasellar region.…”