Primary Pituitary Carcinoma with Spinal Cord Metastasis

Sakamoto, Tetsuya; Itoh, Yasunobu; Fushimi, Susumu; Kowada, Masayoshi; Saito, Masahiro

doi:10.2176/nmc.30.763

Cited by 23 publications

(9 citation statements)

References 20 publications

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“…Because many of the latter were described prior to the routine measurement of PRL or the routine use of immunochemistry, it is likely that the true frequency of PRL cell carcinomas has been grossly underestimated. That this is the case is also suggested by the relative lack of "nonfunctioning" carcinomas in more recent reports 37, 38, 45. Summarizing the literature, the most common endocrinologically functional subtype, PRL cell carcinoma, was represented by 21 cases (47% of functioning tumors), followed by 18 ACTH‐producing tumors (40% of functioning tumors).…”

Section: Discussionmentioning

confidence: 68%

“…With the addition of our 15 cases, 3 of which were previously published, a total of 64 cases of pituitary carcinoma have been reported in the literature published in English to date 1‐51. Forty‐eight (74%) were hormone‐producing, whereas the remaining seventeen (26%) were considered endocrinologically "nonfunctioning."…”

Section: Discussionmentioning

confidence: 99%

“…To date, 52 such cases have been reported in the literature published in English. 1‐51 These include 16 (30%) prolactin (PRL)‐producing tumors,1‐1315 (28%) adrenocorticotropic hormone (ACTH)‐producing tumors,13‐25 6 (10%) growth hormone (GH)‐producing tumors,29‐34 1 (2%) thyroid‐stimulating hormone (TSH)‐producing tumor,35 1 (2%)gonadotropin‐producing tumor,36 and 13 (30%) "nonfunctioning" tumors 30, 37‐51…”

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confidence: 99%

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Pituitary carcinoma

Pernicone

Scheithauer

Sebo

et al. 1997

Cancer

349

110

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BACKGROUND Pituitary carcinomas are rare adenohypophysial neoplasms, the definition, diagnosis, therapy, and prognosis of which are controversial. METHODS Pituitary carcinomas were defined as primary adenohypophysial neoplasms with documented craniospinal and/or systemic metastases. The authors report a clinicopathologic study of 15 examples examined by light microscopy, immunohistochemistry, and image analysis. Both proliferative activity and p53 tumor suppressor gene expression were studied. RESULTS The study group consisted of 15 patients, including 8 males and 7 females ranging in age from 34‐71 years (mean, 56 years). Of these patients, seven had adrenocorticotropic hormone (ACTH)‐producing tumors (four in the context of Nelson's syndrome), seven had prolactin‐producing tumors, and one had a nonfunctioning tumor. No evidence of diabetes insipidus was seen in any case. Fourteen tumors were initially considered macroadenomas. Of the ten cases for whom tumor extent was known, all had invasive tumors. The interval from the initial diagnosis of adenoma to that of carcinoma ranged from 0.3 to 18.0 years (mean, 6.6 years; median, 5.0 years); the longest mean interval (15.3 years) occurred for patients with Nelson's syndrome. The latency was twice as long for ACTH‐producing tumors as for prolactin (PRL) cell tumors (9.5 vs. 4.7 years). All carcinomas showed a greater tendency toward systemic metastasis than craniospinal metastasis; the rate of systemic metastasis was 71% for PRL cell tumors and 57% for ACTH‐producing tumors. Thirteen percent of tumors showed both patterns of metastasis. Fully 50% of primary tumors and the majority of metastases showed nuclear pleomorphism and/or hyperchromasia. The mean mitotic, MIB‐1, and proliferating cell nuclear antigen indices for primary tumors and metastases were as follows: 2/10 high‐power field (hpf), 2.6% and 11%, respectively; 6/10 hpf, 7.8% and 16%, respectively. Staining for p53 protein was noted in 57% of primary tumors and 88% of metastatic tumors; a relative increase in p53 expression in metastases was noted in 83%. All but one of the primary and metastatic tumors were aneuploid. The most common treatments were radiation therapy and, for PRL cell carcinomas, dopamine agonist administration. Both treatments provided only palliation. Eighty percent of the patients died of metastatic disease 7 days to 8 years after the diagnosis of carcinoma; of these, 66% died within 1 year. At last follow‐up, 20% of patients were alive with metastases 9‐18 months after diagnosis. CONCLUSIONS Nearly all pituitary carcinomas present as functioning, microscopically atypical or mitotically active, invasive macroadenomas. By definition, after an interval related to their immunotype, all metastasize. The tumors show a greater tendency toward systemic metastasis than craniospinal metastasis and are associated with poor prognosis. Radiation and dopamine agonist therapy generally provide only palliation. Proliferation indices and p53 expression tend to be higher in metastases than in ...

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pituitary carcinoma

Pernicone

Scheithauer

Sebo

et al. 1997

Cancer

349

110

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“…According to previous reports, most patients with pituitary adenoma who experience recurrences (including intracranial and spinal metastases) have undergone multiple previous surgeries and have received prolonged radiotherapy. 1 , 2 , 5 , 6 , 9 , 11 , 13 , 14 , 16 , 21 , 22 , 24) Further, cerebral spinal fluid (CSF) leakage following transsphenoidal surgery may increase the risk of subsequent subarachnoid dissemination of the tumor. 16) …”

Section: Introductionmentioning

confidence: 99%

Long-Term Follow-Up of Growth Hormone-Producing Pituitary Carcinoma With Multiple Spinal Metastases Following Multiple Surgeries: Case Report

Tanaka

Kato

Aoki

et al. 2013

Neurol. Med. Chir.(Tokyo)

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This report describes a rare case of a patient with growth hormone (GH)-secreting pituitary adenoma with malignant transformation resulting in multiple metastases to the dura mater of the cerebral convexity and high cervical spine. The patient was a 60-year-old man with a previous history of pituitary adenoma with suprasellar extension who had undergone transsphenoidal surgery, craniotomy for a convexity tumor, and suboccipital craniotomy for a cerebellar tumor. Thirteen years after the initial surgery, suboccipital craniotomy for a cervicomedullary junction tumor and cervicospinal surgery for a metastatic tumor was performed. Histologic findings of resected specimens demonstrated that the primary pituitary tumor was typical adenoma (similar to specimens from the initial surgery) but that the cerebellar and the dural tumor from the high cervical spine had a high incidence of mitotic figures, and cellular anaplasia with nuclear polymorphism and necrosis. In addition, the serum levels of GH were noted to have decreased with recurrence of the tumor. It was concluded that patients with pituitary adenoma, even when benign, must be carefully followed for signs of malignant transformation, and spinal or distant metastases.

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“…A total of 45 of 46 (97.8%) published cases described utilizing radiation therapy prior to metastatic progression were reviewed. [1–58–14161719–2325–272931–3739414445474850515658–6062] Eight patients had undergone stereotactic radiosurgery (Mean: 1.13 treatments) prior to progression. Forty patients underwent external radiation therapy (Mean: 1.11 treatments).…”

Section: Discussionmentioning

confidence: 99%

Orbital metastasis of pituitary growth hormone secreting carcinoma causing lateral gaze palsy

Lall

Shafizadeh²,

Lee³

et al. 2013

Surg Neurol Int

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Background:Although pituitary adenoma is one of the most common intracranial tumors, it rarely progresses secondarily into a metastatic carcinoma. Commonalities in reported cases include subtotal resection at presentation, treatment with radiation therapy, and delayed metastatic progression. Pathologic descriptions of these lesions are varying and inconsistent.Case Description:A 52-year-old male was diagnosed with acromegaly and pituitary tumor in 1996. He underwent four subtotal resections and five courses of stereotactic radiosurgery over 14 years. He developed left eye lateral gaze palsy, and was found to have a distant orbital metastasis with involvement of the left lateral rectus and lateral orbital wall. He underwent left orbital craniotomy via eyebrow incision for resection of this lesion. Pathologic evaluation showed a markedly elevated Ki67 level of 30%.Conclusion:While overall incidence of metastatic progression of pituitary adenoma after radiotherapy appears to be low, it appears to be a possible complication, and could be more likely in patients receiving multiple doses of radiotherapy. Our review of reported cases showed that 45/46 (97.8%) of patients developing carcinoma had prior radiation exposure. These patients may also have more aggressive pathologic characteristics of their lesions.

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Primary Pituitary Carcinoma with Spinal Cord Metastasis

Cited by 23 publications

References 20 publications

Pituitary carcinoma

Pituitary carcinoma

Long-Term Follow-Up of Growth Hormone-Producing Pituitary Carcinoma With Multiple Spinal Metastases Following Multiple Surgeries: Case Report

Orbital metastasis of pituitary growth hormone secreting carcinoma causing lateral gaze palsy

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