Collision tumors composed of meningioma and growth hormone-secreting pituitary adenoma in the sellar region

Abstract

Rationale:Collision tumor is a rare disease that represents the coexistence of two histologically distinct neoplasms in the same area without histological admixture or an intermediate cell population zone. To our best knowledge, 13 cases besides our 2 cases have been reported till now, and our report represents the first publication regarding a collision tumor composed of growth hormone (GH)-secreting pituitary adenoma and sellar meningioma.Patient concerns:We collected two cases of collision tumors composed of meningioma and GH-secreting adenoma in the sellar region from 2014 to 2015 at Peking Union Medical College Hospital (PUMCH).Diagnosis:Two cases were diagnosed with solid sellar tumors, and two tumor types were suspected with magnetic resonance imaging (MRI). Blood hormone tests revealed increased insulin-like growth factor 1 (IGF-1) and GH levels.Interventions:Both cases underwent transsphenoidal microsurgical resection of pituitary adenoma.Outcomes:The tumor was completely resected, and the pathological examination after the operation revealed meningioma and GH-secreting pituitary adenoma.Lessons:Collision tumors consisting of pituitary adenomas with other sellar neoplasms are rare. Histological examination is necessary because preoperative studies cannot guarantee an accurate diagnosis. If a collision tumor is suspected prior to operation, a craniotomy may need to be considered before other operation methods to avoid reoperation.

Unexpected concomitant pituitary adenoma and suprasellar meningioma: a case report and review of the literature

“…A preference for parasellar localization was found with 22 cases, [4][5][6]10,13,14,16,22,[25][26][27]29,31,[33][34][35][36][38][39][40] of which in 13 cases the tumours were contigious. 6,10,14,22,26,27,31,33,35,[38][39][40] In only three a distinction had been made between the tumours preoperatively. 26,27,32 When a meningioma or a pituitary adenoma becomes symptomatic and a MRI is made it is possible that an incidental meningioma or pituitary adenoma is seen.…”

“…However, 5 of the 10 cases occurred in the last five years. 22,26,35,40 Our literature review will be an underrepresentation of the real prevalence. During a retrospective study concerning pituitary adenomas seven other patients were found that were diagnosed with a pituitary adenoma and a concomitant meningioma in our hospital during the last seven years.…”

“…34 In literature we indeed see a higher proportion of GH-producing adenomas with concomitant meningioma (30.6%). 4,5,[9][10][11]17,20,21,24,29,30,32,35,40 The mechanism through which the GH-adenomas would possibly influence the meningiomas is unclear, but 75% of meningiomas do express GH and IGF-I receptors. 41 Until now no overlapping genetic factors have been discovered in pituitary adenomas and meningiomas.…”

Cushing’s disease due to a pituitary adenoma as a component of collision tumor: A case report and review of the literature

“…In a series of 548 transsphenoidally resected pituitary adenomas, collision tumors accounted for 1.46% [5]. Collision tumors containing pituitary adenoma-sellar meningioma have been described in only four cases to date [6][7][8]. As the fifth case, we present a case harboring a collision tumor comprising a pituitary corticotroph adenoma and a sellar meningioma in the same anatomic position.…”

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

“…The presence of a lung lesion could also represent a second primary; however, microscopic and immunohistochemical findings did not support a lung origin. Meningioma may also be a consideration as part of a sellar collision tumor with pituitary adenoma [19,37], and a clear cell meningioma may resemble clear cell renal cell [38,39]; however, recent studies have reported VHL inactivation alone is insufficient to cause tumor formation [40]. We do not have germ cell data to ascertain if our patient had VHL disease; however, the presence of VHL and NOTCH2 in both tissue samples and the history or renal clear cell carcinoma suggest an abnormality that points towards germ-line mutation.…”