Pituitary Metastatic Composite Tumors: A Case Report with Next-Generation Sequencing and Review of the Literature

Abstract

Background. While pituitary tumors are well understood, little research has been done on metastasis from primary tumors into pituitary adenomas, also known as composite tumors. Because only 34 cases of composite tumors have been reported to date, we hope to better characterize these tumors by reviewing cases reported in the literature and reviewed our own documented case, which includes next-generation sequencing. Case Presentation. A 74-year-old man presented to the emergency department with left vision loss for 3 months. He had a history of colon cancer treated with colectomy and clear cell renal carcinoma treated with left nephrectomy. A preoperative MRI demonstrated growth of a peripherally enhancing, centrally necrotic mass with sellar expansion measuring 5.7×3.1×3.0 cm. Given these findings, an endoscopic endonasal transsphenoidal resection was performed. Histological assessment revealed a composite tumor: one neoplasm was a nonfunctioning pituitary adenoma, and another neoplasm was a clear cell carcinoma. Next-generation sequencing demonstrated that the tumors shared mutations in VHL and Notch2. The patient died 2 months later from systemic metastatic cancer. Conclusion. From our literature review, most metastatic lesions in these composite tumors originated from neoplasms of the lung and kidney. Approximately 63% patients presented with ophthalmoplegia as the initial symptom while 23% displayed hormonal abnormalities. Postoperative mortality had a median of 3.5 months. In our patient, the presence of VHL and Notch2 mutations in both tumors highlights the possibility of using next-generation sequencing to help identify therapeutic targets even in complex composite neoplasms.

Metastasis of breast adenocarcinoma to pituitary adenoma

“…Over oneyear postoperative follow-up showed no recurrence of the neoplastic process of both pituitary tumors. The relatively long survival time is unusual for similar cases [1,2].…”

“…Tumor-to-tumor intracranial metastasis is an uncommon phenomenon, and it occurs extremely rarely to pituitary adenoma [1]. Contrary to adenomas, which are the most frequent neoplastic lesions of the pituitary gland and metastases to normal pituitary gland, which account for 2% of all pituitary lesions, only about 35 cases of metastases to pituitary adenoma have been described [2]. The most frequently reported malignancies that metastasize to pituitary adenomas are lung, renal and breast cancers [1,2].…”

“…Contrary to adenomas, which are the most frequent neoplastic lesions of the pituitary gland and metastases to normal pituitary gland, which account for 2% of all pituitary lesions, only about 35 cases of metastases to pituitary adenoma have been described [2]. The most frequently reported malignancies that metastasize to pituitary adenomas are lung, renal and breast cancers [1,2]. The prognosis for metastases to pituitary adenoma is poor due to the presence of advanced neoplastic disease [3].…”

Exactitud dosimétrica en tratamiento de radiocirugía mediante arcoterapia dinámica conformada y arcoterapia volumétrica modulada

“…Entre las opciones de tratamiento se encuentran la resección quirúrgica, medicación y radioterapia. La SRS conserva la funcionalidad del nervio óptico y el quiasma [20].…”

“…Se deben almacenar las PRC en lugares alejados de las fuentes de radiación ionizante y así evitar posibles exposiciones de la PRC previa a su uso. Los pacientes con Malformaciones Arteriovenosas (MAV) corresponde al 40 % y dosis de prescripción [16][17][18][19][20]Gy. Los Neurinomas (NUE), principalmente del nervio acústico, con un 25 % y dosis de prescripción entre [12][13][14][15] Gy.…”