Craniopharyngioma in a patient with acromegaly due to a pituitary macroadenoma

Abstract

We present the first reported case of a craniopharyngioma as a second primary tumor in a patient with acromegaly due to a growth hormone (GH)-secreting pituitary adenoma. The patient was lost for follow-up for 18 years after trans-sphenoidal pituitary surgery for a GH-secreting pituitary adenoma. She presented with headaches and decreased visual acuity, and showed unsuppressed GH in an oral glucose load test with high IGF-1 levels. Brain MRI showed a suprasellar cystic mass and the patient underwent surgery for cyst drainage resulting in postoperative improvement in her vision. Biopsy of the mass confirmed the diagnosis of a craniopharyngioma. We stress the need for close follow-up of patients with acromegaly with adequate control of GH and IGF-1 levels.

Papillary craniopharyngioma in a patient following resection of nonfunctioning pituitary adenoma: illustrative case

“…28 Furthermore, very few cases exist of any CP presenting in a patient after resection of a PA. We found two reports of the metachronous presentation of a CP and a functioning PA (Table 1). 29,30 Most notably, when examining the two other previously reported cases of NPA leading to PCP, we noted our current patient was significantly older. The three patients were each lost to follow-up prior to presentation with CP.…”

“…To the best of our knowledge, since 1971, there have been only 17 cases of synchronous collision tumors, rare clinical entities wherein two histologically distinct tumor types occur at the same anatomical location simultaneously or within 6 months of one another. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Metachronous collision of NPAs and CPs being diagnosed at least 6 months apart have been reported only twice in the previous literature, with a CP arising in a patient after surgery for a functioning PA. 29,30 To our knowledge, this is the first reported case of a PCP developing in a patient after resection of an NPA.…”

Synchronous Morphologically Distinct Craniopharyngioma and Pituitary Adenoma: A Rare Collision Entity

“…Both, pituitary adenoma and craniopharyngioma are ontogenetically related, and there is documented evidence of presence of squamous nests with metaplastic potential in the pars tuberalis. A metaplastic change in pituitary adenoma following irradiation can also explain the rare coexistence of pituitary adenoma and craniopharyngioma in the same tumor [4][5][6]. Only nine well documented cases of coexistence of pituitary adenoma and craniopharyngioma have been reported so far (Table 1) [1,3,4,[7][8][9][10][11][12][13].…”

“…In all others, the two tumor elements were mixed and could be distinctly identified by light microscopy and immunohistochemistry. Interestingly, El-Bilbeisi, et al [5] reported occurrence of craniopharyngioma in a patient with acromegaly due to pituitary adenoma; the two tumours were separated by a decade.…”

“…Gonadotroph adenoma and Corticotroph adenoma 5 Moshkin, et al [8] Calcified craniopharyngioma Nonfunctioning adenoma (subtype 3) 6 Prabhakar, et al [10] Foci of squamous cell rests…”