Pituitary Metastases: Role of Surgery

Zoli, Matteo; Mazzatenta, Diego; Faustini‐Fustini, Marco; Pasquini, Ernesto; Frank, Giorgio

doi:10.1016/j.wneu.2012.03.018

Cited by 41 publications

(53 citation statements)

References 12 publications

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“…5 These tumors account for only 1% of surgically treated pituitary tumors. 8,16,31 Recently, as the number of patients diagnosed with cancer has increased and their survival time has been extended, PMs have been diagnosed more frequently than before. 16,20,24 Many authors have reported their own experiences or their institutional series on PMs.…”

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confidence: 99%

Pituitary metastases: current practice in Japan

Habu

Tokimura

Hirano

et al. 2015

JNS

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A lthough malignant tumors metastasizing into the pituitary fossa are not infrequent events in autopsy series, 6,10,17,18 pituitary metastasis (PM) is rarely diagnosed ante mortem. 3,14,18 According to the Brain Tumor Registry of Japan, only 0.4% of intracranial metastatic tumors are located in the pituitary gland. 5 These tumors account for only 1% of surgically treated pituitary tumors. 8,16,31 Recently, as the number of patients diagnosed with cancer has increased and their survival time has been extended, PMs have been diagnosed more frequently than before. 16,20,24 Many authors have reported their own experiences or their institutional series on PMs. 3,11,13,14,20,26,31 There are also reviews involving large numbers of reported cas- results Between 1995 and 2010, 201 patients with PMs were treated by the participating physicians. The diagnosis of PM was histologically verified in 69 patients (34.3%). In the other 132 patients (65.7%), the PM was diagnosed by their physicians based on neuroimaging findings and clinical courses. The most frequent primary tumor was lung (36.8%), followed by breast (22.9%) and kidney (7.0%) cancer. The average interval between diagnosis of primary cancer and detection of PM was 2.8 ± 3.9 (SD) years. Major symptoms at diagnosis were visual disturbance in 30.3%, diabetes insipidus in 27.4%, fatigue in 25.4%, headache in 20.4%, and double vision in 17.4%. Major neuroimaging features were mass lesion in the pituitary stalk (63.3%), constriction of tumor at the diaphragmatic hiatus (44.7%), hypothalamic mass lesion (17.4%), and hyperintensity in the optic tract (11.4%). Surgical treatment was performed in 26.9% of patients, and 74.6% had radiation therapy; 80.0% of patients who underwent radiotherapy had stereotactic radiotherapy. The median survival time was 12.9 months in total. Contributing factors for good prognosis calculated by Cox proportional hazard analysis were younger age, late metastasis to the pituitary gland, smaller PM size, and radiation therapy. The Kaplan-Meier survival was significantly better in patients with breast cancer and renal cell cancer than in those with lung cancer. coNclusioNs At the time of this writing, approximately 60% (120/201) of PMs had been treated by stereotactic radiation therapy in Japan. The median survival time was much longer than that reported in past series. To confirm the changes of clinical features and medical practice, a prospective and population-based survey is mandatory.

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confidence: 99%

Pituitary metastases: current practice in Japan

Habu

Tokimura

Hirano

et al. 2015

JNS

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“…As suggested by previous studies, when overt symptoms, such as visual disturbances and headaches, or a marked increase in the size of the lesion over a short period of time requires treatment, but surgery cannot be considered, an attractive and effective therapeutic option is radiation therapy, either traditional or sterotactic (5,14). STR was suggested for one of the patients in the present study, but disease spread with critical clinical deterioration did not allow for any further treatment.…”

Section: Discussionmentioning

confidence: 57%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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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“…За даними літератури, частота діагностуван-ня вторинних уражень гіпофіза -від 1 до 19% [8,9]. Відзначено, що у разі виявлення за даними нейрові-зуалізації пухлинного утворення в селярній ділянці та за наявності онкологічного анамнезу це утворення в 90% випадків є метастазом [10][11][12][13]. Частота мета-стазів у гіпофіз, які дають симптоматику, становить від 4,5 до 3,0% [13][14][15][16].…”

Section: украинский нейрохирургический журнал 2018;(1):78-83unclassified