Combined Sellar Fibrosarcoma and Prolactinoma with Neuronal Metaplasia: Report of a Case Unassociated with Radiotherapy

Abstract

We report the occurrence of a primary pituitary fibrosarcoma causally unrelated to radiotherapy, admixed in association with a prolactin cell pituitary adenoma showing neuronal metaplasia. These unique findings were associated with multiple endocrine neoplasia type 1 (MEN 1). Primary fibrosarcoma involving the sella is a very rare tumor. The majority of cases have been associated with prior irradiation of either a pituitary adenoma or a craniopharyngioma. Pituitary adenoma with neuronal metaplasia is also rare and usually occurs in the setting of acromegaly. Despite the intimate association of both elements in our lesion, no transition of adenoma to sarcoma was demonstrable by immunohistochemistry or in situ hybridization studies.

Primary pituitary fibrosarcoma presenting with multiple metastases: A case report and literature review

“…Sarcomatous changes in sellar lesions do not necessarily indicate malignant or metastatic potential; few patients with PF secondary to sellar radiotherapy or pituitary adenoma showed relapse or metastasis after total resection. [1][2][3][4][5][6][7][8][9] These differences in clinical presentation and histopathology demonstrate that, compared with secondary PF, PPF has a higher of grade malignancy, including rapid Three different etiologic forms of PF have been documented in the literature: (1) radiotherapyinduced fi brosarcomatous transformation of pituitary lesions, such as adenoma or craniopharyngioma, which comprises the overwhelming majority of all PF case reports; [2][3][4][5][6] (2) spontaneous fi brosarcomatous transformation of primary prolactinoma without a recognizable cause; [1,[7][8][9] and (3) spontaneous fibrosarcomatous changes in the pituitary gland, which may metastasize to other areas of the head and pathologically appears to be the most malignant of the three types. [10,11] The patient in this report had the third form of PF, and was limited to a lifespan of only 11 months from diagnosis despite a multimodal treatment regimen combining surgery, chemotherapy, and radiotherapy.…”

“…[2][3][4][5][6][7][8][9][10][11] Almost all these cases have been considered to be radiotherapy-induced complication in patients with pituitary adenoma or craniopharyngioma [2][3][4][5][6] or a spontaneous malignant transformation of prolactinoma. [7][8][9] Till date only two cases of primary PF (PPF), unrelated to irradiation or adenoma, have been published. [10,11] Here we report a third pathologically confi rmed case of PPF.…”

Compound gonadotrophic pituitary adenoma and rhabdomyosarcoma

“…In this case, the patient had a thymic carcinoma with metastatic disease treated with etoposide, and a subsequent prolactinoma treated with bromocriptine without radiotherapy. After 8 years, radiological examination revealed a large pituitary mass, which, on histological examination, was compatible with fibrosarcoma in close association with pituitary adenoma . Moro argues that this drug tends to cause fibrosis in the pituitary stroma.…”

“…reported two neoplastic cases, represented by a vascular‐rich stroma surrounded by spindle cells with smooth muscle differentiation and associated with pituitary adenoma, which they called leiomyomatoid angiomatous neuroendocrine tumour. Moro et al . reported a case of combined sellar fibrosarcoma and prolactinoma, without prior radiotherapy.…”

Lesions within and around the Pituitary

“…Germinomas usually show prominent contrast enhancement and present well-defined margins. Individual case reports describe sellar lesions that radiologically cannot be differentiated from pituitary adenomas, such as chondrosarcomas, granular cell tumors [ 68,69], gangliocytomas [70,71], fibrosarcomas [72,73], hemangiopericytomas [74], esthesioneuroblastomas [75], melanomas [76], ependymomas [77], or lymphomas [78].…”