Pituitary metastases of Hürthle cell carcinoma of the thyroid

Abstract

An 85-year-old man was referred to endocrinology following the discovery of an incidental pituitary mass on cranial imaging which was thought to be a non-functioning adenoma during an admission with headaches, lethargy, confusion and hyponatraemia. He had a history of Hürthle cell carcinoma of the thyroid treated with total thyroidectomy, ablative radioiodine therapy and thyroxine replacement. Subsequently, he developed metastatic spread to the neck, lungs and skeleton. About 9 months later, the patient had deterioration of vision. MRI showed a rapidly expanding pituitary mass with compression of the optic chiasm. Biochemical investigations confirmed hypocortisolism and hypogonadism. The patient underwent trans-sphenoidal resection of the pituitary mass followed by external beam radiotherapy to the pituitary bed. Histopathology confirmed a metastatic deposit of Hürthle cell carcinoma, which is a rare and aggressive variant of follicular thyroid carcinoma.

Pituitary Metastases From Differentiated Thyroid Cancers: A Systematic Review

“…The results of the quality assessment of the eligible studies are shown in Supplementary Material 2 ( www.wjon.org ) [ 5 , 9 , 10 , 15 - 36 ]. Twenty studies had moderate quality, while the remaining five were rated low.…”

“…PM from differentiated thyroid cancer (DTC) is extremely uncommon and represents a rare site for metastases [ 5 - 8 ]. Less than 30 cases have been reported in the literature [ 9 , 10 ]. Some reports have indicated differences in PM manifestations in the DTC setting compared to non-thyroid cancers.…”

“…Some reports have indicated differences in PM manifestations in the DTC setting compared to non-thyroid cancers. For example, Barbaro et al [ 9 ] and Ilerhunmwuwa et al [ 10 ] suggested that DI was an infrequent finding in PM from DTC.…”

Surgical management of metastatic Hürthle cell carcinoma to the skull base, cortex, and spine: illustrative case

“… 15 , 16 Metastasis to the brain is very rare in all subtypes of metastatic thyroid carcinoma; to our knowledge, only 3 cases of HCC metastasis to the central nervous system have been reported. 3 McWilliams et al 15 found that median survival for patients with metastatic thyroid carcinoma to the brain was 20.8 months for patients who had undergone partial or gross-total resection, but this was further reduced to only 8.3 months when evaluating patients with carcinomas of follicular cell origin. Patients who did not undergo any resection had a median survival of 2.7 months.…”

“… 1 Hürthle cell carcinoma typically metastasizes to the lung and bones, with brain metastases (BMs) being uncommon. 2 However, rare cases of pituitary metastases, 3 skull metastases, 4 single choroid plexus metastasis, 5 and cerebral metastasis 6 of HCC have been reported in the literature. Patients with distal DTC metastasis have poor outcomes, and those with BM have a worse overall survival, ranging from 7.1 to 33 months.…”