Metastases to the Pituitary Gland: Histological Patterns of Spread and Review of the Literature

2021 ◽  
Author(s):  
B K Kleinschmidt-DeMasters
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Surgical Excision ◽  
Disease Course ◽  
Review Of The Literature ◽  
Metastatic Cells ◽  
Filling Pattern ◽  
Pituitary Metastases ◽  
Atypical Pituitary Adenoma ◽  
Disease Stages

Abstract Few studies have focused on histological patterns of metastatic spread to the pituitary gland. We review our experience and that in the literature, 1970–present. Departmental cases, 1998–2021, were assessed for anterior versus posterior gland and/or capsular involvement and cohesive tumor obliterating underlying pituitary architecture versus metastatic cells filling pituitary acini with relative acinar preservation. Eleven autopsy/15 surgical cases, including 2 metastases to pituitary adenomas, were identified. Cohesive/obliterative patterns predominated histologically in both surgical and autopsy cases, but acinar filling by metastatic cells was extensive in 3/26 cases, focal in 5/26, and had resulted in initial erroneous impressions of atypical pituitary adenoma/pituitary carcinoma in 1 case and pituitary adenoma with apoplexy in another, likely due to focusing on necrotic areas in the specimen where the acinar pattern had been broken down and not appreciating nearby areas with acinar filling by metastatic cells. Although most pituitary metastases produce readily identifiable cohesive/obliterative patterns, diagnostic challenges remain with the less frequently seen “acinar filling” pattern. A dichotomy exists between patients with symptomatic pituitary metastases occurring early in the disease course and requiring surgical excision versus patients in whom asymptomatic small pituitary metastases are found incidentally at autopsy, the latter almost invariably in late disease stages, with widely disseminated metastatic disease.

scholarly journals Atypical pituitary adenoma with orbital invasion: Case report and review of the literature

2017 ◽  
Vol 62 (6) ◽  
pp. 867-874 ◽  
Author(s):  
Mina M. Naguib ◽  
Pia R. Mendoza ◽  
Supharat Jariyakosol ◽  
Hans E. Grossniklaus
Keyword(s):  
Case Report ◽  
Pituitary Adenoma ◽  
Review Of The Literature ◽  
Atypical Pituitary Adenoma ◽  
Orbital Invasion

Atypical Pituitary Adenoma: A Clinicopathologic Case Series

2016 ◽  
Vol 77 (S 01) ◽  
Author(s):  
Martin Rutkowski ◽  
Ryan Alward ◽  
Derek Southwell ◽  
Rebecca Chen ◽  
Jeffrey Wagner ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Case Series ◽  
Atypical Pituitary Adenoma

scholarly journals Parosteal Osteosarcoma with Pancreatic Metastasis and Multiple Relapses: A Case Report and Review of the Literature

2021 ◽  
pp. 983-988
Author(s):  
Daniel Cirotski ◽  
Jyoti Panicker
Keyword(s):  
Age Groups ◽  
Bone Cancer ◽  
Pancreatic Metastasis ◽  
Low Grade ◽  
Parosteal Osteosarcoma ◽  
Disease Course ◽  
Review Of The Literature ◽  
Histologic Subtype ◽  
Primary Bone ◽  
Multiple Relapses

Osteosarcoma is the most common primary bone cancer in all age groups. Metastasis mostly occurs with high-grade tumors disseminating to the lungs and other bones. Spread to the pancreas is rare and undocumented in the low-grade subtypes. Additionally, it is uncommon for the disease course of low-grade subtypes to involve multiple relapses. We present a 35-year-old woman with parosteal osteosarcoma who has experienced an atypical metastasis to the pancreas as well as multiple local and pulmonary relapses. The lesion was identified incidentally on routine imaging, and the patient underwent resection. We compare our case to the other reports of pancreatic metastasis in the literature. Despite being especially rare, clinicians ought to be aware of pancreatic metastasis of osteosarcoma. Furthermore, despite parosteal osteosarcoma’s less aggressive disease course, it can uncommonly lead to multiple relapses. We present a rare case exemplifying these phenomena in the prognostically favorable histologic subtype of parosteal osteosarcoma.

scholarly journals The combination of 13N-ammonia and 11C-methionine in differentiation of residual/recurrent pituitary adenoma from the pituitary gland remnant after trans-sphenoidal Adenomectomy

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fangling Zhang ◽  
Qiao He ◽  
Ganhua Luo ◽  
Yali Long ◽  
Ruocheng Li ◽  
...  
Keyword(s):  
Quantitative Analysis ◽  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Gray Matter ◽  
Standard Uptake Value ◽  
Visual Evaluation ◽  
Additional Surgery ◽  
Pet Ct ◽  
Histological Confirmation ◽  
G Ratio

Abstract Background This study aimed to assess the clinical usefulness of 13N-ammonia and 11C- Methionine (MET) positron emission tomography (PET)/ computed tomography (CT) in the differentiation of residual/recurrent pituitary adenoma (RPA) from the pituitary gland remnant (PGR) after trans-sphenoidal adenomectomy. Methods Between June 2012 and December 2019, a total of 19 patients with a history of trans-sphenoidal adenomectomy before PET/CT scans and histological confirmation of RPA after additional surgery in our hospital were enrolled in this study. Images were interpreted by visual evaluation and semi-quantitative analysis. In semi-quantitative analysis, the maximum standard uptake value (SUVmax) of the target and gray matter was measured and the target uptake/gray matter uptake (T/G) ratio was calculated. Results The T/G ratios of 13N-ammonia were significantly higher in PGR than RPA (1.58 ± 0.69 vs 0.63 ± 1.37, P < 0.001), whereas the T/G ratios of 11C-MET were obviously lower in PGR than RPA (0.78 ± 0.35 vs 2.17 ± 0.54, P < 0.001). Using the canonical discriminant analysis, we calculated the predicted accuracy of RPA (100%), PGR (92.9%), and the overall predicted accuracy (96.43%). Conclusions The combination of 13N-ammonia and 11C-MET PET/CT is valuable in the differentiation of RPA from PGR after trans-sphenoidal adenomectomy.

Treatment of Invasive Silent Somatotroph Pituitary Adenoma with Temozolomide. Report of a Case and Review of the Literature

2015 ◽  
Vol 26 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Ali A Ghazi ◽  
Fabio Rotondo ◽  
Kalman Kovacs ◽  
Alireza Amirbaigloo ◽  
Luis V Syro ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Review Of The Literature

scholarly journals Nasal Epithelial Myoepithelial Carcinoma: An Unusual Cause of Epiphora, a Case Report and Review of the Literature

2015 ◽  
Vol 6 (2) ◽  
pp. ar.2015.6.0127 ◽  
Author(s):  
Juliette O. Flam ◽  
Christopher D. Brook ◽  
Rachel Sobel ◽  
John C. Lee ◽  
Michael P. Platt
Keyword(s):  
Case Report ◽  
Physical Examination ◽  
Nasal Cavity ◽  
Surgical Excision ◽  
Myoepithelial Carcinoma ◽  
Review Of The Literature ◽  
Nasal Symptoms ◽  
First Case ◽  
Nasal Tumor ◽  
Epithelial Myoepithelial Carcinoma

Introduction Epithelial myoepithelial carcinoma (EMC) of the nasal cavity is a rare tumor, and here we describe the first case of EMC of the nasal cavity presenting with epiphora. A case presentation and review of the literature is provided. Methods A case report is described of a 63-year-old man who presented with unilateral epiphora and was found via a thorough history and physical examination to have a nasal tumor. The physical examination consisted of an ocular examination, including probing and irrigation, and a detailed nasal examination (anterior rhinoscopy, nasal endoscopy). The nasal examination was prompted by the patient's report of concurrent nasal symptoms during history taking. Immunohistochemistry subsequently identified the nasal tumor as EMC. A literature search was performed to gain insights into similar malignancies of the nasal cavity. Results Eight cases of EMC of the nasal cavity were identified in the literature, none of the patients presented with epiphora. The case presented here resulted in resolution of the patient's symptoms and no evidence of disease after surgical excision. Conclusion Epithelial myoepithelial is a rare salivary gland malignancy that can arise in the nasal cavity. Unilateral epiphora with concurrent nasal symptoms should prompt nasal cavity examination for the possibility of an obstructive tumor.

scholarly journals Metastases to the pituitary gland

2004 ◽  
Vol 16 (4) ◽  
pp. 1-4 ◽  
Author(s):  
Daniel R. Fassett ◽  
William T. Couldwell
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Skull Base ◽  
Survival Rates ◽  
Tumor Resection ◽  
Sella Turcica ◽  
Pituitary Tumors ◽  
Visual Field Defects ◽  
Malignant Neoplasms ◽  
Pituitary Metastases

Only 1% of all pituitary surgeries are performed to treat tumors that have metastasized to the pituitary gland; however, in certain cases of malignant neoplasms pituitary metastases do occur. Breast and lung cancers are the most common diseases that metastasize to the pituitary. Breast cancer metastasizes to the pituitary especially frequently, with reported rates ranging between 6 and 8% of cases. Most pituitary metastases are asymptomatic, with only 7% reported to be symptomatic. Diabetes insipidus, anterior pituitary dysfunction, visual field defects, headache/pain, and ophthalmoplegia are the most commonly reported symptoms. Diabetes insipidus is especially common in this population, occurring in between 29 and 71% of patients who experience symptoms. Differentiation of pituitary metastasis from other pituitary tumors based on neuroimaging alone can be difficult, although certain features, such as thickening of the pituitary stalk, invasion of the cavernous sinus, and sclerosis of the surrounding sella turcica, can indicate metastasis to the pituitary gland. Overall, neurohypophysial involvement seems to be most prevalent, but breast metastases appear to have an affinity for the adenohypophysis. Differentiating metastasis to the pituitary gland from bone metastasis to the skull base, which invades the sella turcica, can also be difficult. In metastasis to the pituitary gland, surrounding sclerosis in the sella turcica is usually minimal compared with metastasis to the skull base. Treatment for these tumors is often multimodal and includes surgery, radiation therapy, and chemotherapy. Tumor invasiveness can make resection difficult. Although surgical series have not shown any significant survival benefits given by tumor resection, the patient's quality of life may be improved. Survival among these patients is poor with mean survival rates reported to range between 6 and 22 months.

scholarly journals An unrecognized endocrinology emergency masquerading as a hypertensive emergency: A can’t miss diagnosis

2016 ◽  
Vol 4 (1) ◽  
pp. 21
Author(s):  
Yanerys Agosto Vargas ◽  
Sharon Velez Maymi ◽  
Paola Mansilla Letelier ◽  
Luis Raul Hernandez-Vazquez ◽  
Samayra Miranda Rodriguez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pituitary Adenoma ◽  
Mortality Rate ◽  
Pituitary Gland ◽  
Pituitary Apoplexy ◽  
Systemic Hypertension ◽  
Pituitary Macroadenoma ◽  
Rare Entity ◽  
Factors Associated ◽  
Multiple Risk Factors

Pituitary apoplexy secondary to sellar tumors is a rare entity that carries a high mortality rate. It could be secondary to infarction or hemorrhage of the pituitary gland. The incidence remains unclear, most are reported in men between the ages of 50 to 60. In the majority of times, apoplexy is idiopathic in nature, without a clear discernible cause. However, there are multiple risk factors associated with this entity, such as systemic hypertension, among others. There are few cases of pituitary apoplexy caused by infarction of a pituitary macroadenoma. We present this case of pituitary apoplexy secondary to infarction of a nonfunctional pituitary adenoma in a young woman, with a fortunate resolution.

scholarly journals Atypical Pituitary Adenoma: A Clinicopathologic Case Series

2017 ◽  
Vol 78 (S 01) ◽  
pp. S1-S156
Author(s):  
Martin Rutkowski ◽  
Ryan Alward ◽  
Rebecca Chen ◽  
Jeffrey Wagner ◽  
Arman Jahangiri ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Case Series ◽  
Atypical Pituitary Adenoma
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