Cytopathologic Features of Pituitary Carcinoma with Cervical Vertebral Bone Metastasis

Ceyhan, Koray; Yağmurlu, Banu; Dogan, Basak E.; Erdoğan, Nural; Bulut, Şafak; Erekul, Selim

doi:10.1159/000325938

Cited by 11 publications

(18 citation statements)

References 18 publications

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“…Of all reported cases, 18 patients (31%) were still alive at publication of the data with a follow-up after initial presentation of 0-7 years after the diagnosis of metastases; four with solitary liver metastases [21,32,42,45], two with multiple sites of metastases [27,39], five with solitary bone metastases (our case, [15,21,26,42]) as discussed above. The other patients had solitary lymph node metastases (n = 2) which were extirpated [12,48] or metastases in the central nervous system (n = 5) for which surgery [8,24,29,30], or combined surgery and radiotherapy was applied [21].…”

Section: Discussionmentioning

confidence: 81%

“…In our second case, Cushing's disease recurred two times for which the patient was treated by transsphenoidal surgery, bilateral adrenalectomy, and radiotherapy. Recurrences of Cushing's disease were reported frequently in the other case reports of malignant Cushing's disease; one recurrence was reported in 15 patients [8, 11, 12, 17, 18, 20-22, 30, 34, 35, 40, 45, 47, 48], two recurrences in 7 patients [13,14,21,24,26,44] and three or more recurrences in 10 patients [15,19,21,23,28,29,32,37,39,41]. Nelson's syndrome, defined as pituitary tumor progression after bilateral adrenalectomy, developed in one of our patients.…”

Section: Discussionmentioning

confidence: 95%

“…A few metastases were asymptomatic and only found during routine follow-up screening for (recurrent) Cushing's disease [12,13,23,46]. Most of the metastases, however, caused problems such as pain or local compression due to local growth in liver [12,21,25,27,32,39,45], bones [8,11,14,18,26,35], and the central nervous system [15,17,21,22,24,[29][30][31]. In nine cases metastases were found only by postmortem analysis in the liver, intracranial, meninges, and spinal cord [16,19,20,28,34,36,38,43,47].…”

Section: Discussionmentioning

confidence: 99%

“…Those patients had been treated with surgery (our case, [15]), with radiotherapy [21,26], and with combined chemotherapy and radiotherapy [26]. Time interval to death in the other four cases ranged from 0.4 to 2.7 years [3,15,22,40]. In 10 cases, metastases were found only in the liver [16,20,21,32,36,38,[42][43][44][45].…”

Section: Discussionmentioning

confidence: 99%

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Malignant pituitary corticotroph adenomas: report of two cases and a comprehensive review of the literature

et al. 2008

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Corticotroph pituitary carcinomas are tumors, defined by the presence of distant metastases that determine their poor prognosis. The diagnosis and therapy of malignant corticotroph adenomas remains a clinical challenge. The molecular mechanisms of malignant transformation of pituitary adenomas are unclear, although they are believed to arise in an adenoma-to-carcinoma sequence. We describe two cases of malignant Cushing's disease with metastases in liver and bone, respectively. The primary pituitary tumors were treated by a combination of radiotherapy and transsphenoidal surgery, but recurred several times in both patients. The time interval between the diagnosis of Cushing's disease and the discovery of metastases was 32 and 17 years, respectively. In the first case the patient died within 6 months after diagnosis of metastasis, whereas the second patient is alive at a followup of 2 years after the discovery of the metastasis. Furthermore, we reviewed all available cases of corticotroph pituitary carcinomas reported in the literature and analyzed their clinical features and therapeutical management. In conclusion, frequent relapses of Cushing's disease, aggressive growth of macroadenoma, Nelson's syndrome after adrenalectomy or persistently high ACTH levels should prompt the clinician to consider the possibility of pituitary corticotroph carcinomas.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Malignant pituitary corticotroph adenomas: report of two cases and a comprehensive review of the literature

et al. 2008

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“…Pituitary carcinomas are extremely uncommon tumors, with approximately 170 cases reported in the literature [4] . A diagnosis of pituitary carcinoma by fine needle aspiration (FNA) is exceedingly rare, with a total of 2 cases of metastases to liver, 2 to cervical lymph nodes, and 1 to vertebral bone reported in the literature [5][6][7][8] . The cytologic features of pituitary carcinoma are poorly characterized in part due to the rarity of the disease.…”

Section: Introductionmentioning

confidence: 99%

Metastatic Pituitary Carcinoma to Cervical Lymph Node: Diagnosis by Fine Needle Aspiration and Review of the Literature

Wang

Liang²,

Yong³

et al. 2017

Acta Cytologica

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Background: Pituitary carcinomas are rare neoplasms whose designation requires demonstration of metastatic disease. No specific morphologic features can reliably distinguish pituitary carcinomas from pituitary adenomas, rendering the diagnosis particularly challenging. Furthermore, as reports of pituitary carcinoma on fine needle aspiration (FNA) biopsy are exceedingly rare in the literature, the cytological features of pituitary carcinoma are poorly characterized. Case Report: Here we describe a case of pituitary carcinoma in a 67-year-old woman with history of recurrent adrenocorticotropic hormone (ACTH)-producing pituitary adenoma who presented with a persistent left cervical nodule for 2 years. Ultrasound-guided FNA of the nodule consisted of loosely cohesive clusters of epithelioid cells with marked cytologic atypia, intermediate to large nuclei, relatively irregular nuclear contour, coarse granular chromatin, prominent nucleoli, and delicate finely granular cytoplasm. Immunohistochemical stains performed on the cell block revealed positivity for synaptophysin, chromogranin and ACTH with an increased Ki-67 proliferation index (approximately 25%). Review of the patient's previously resected pituitary tumor showed similar cytomorphologic features. Conclusion: Given the similar cytologic features of pituitary carcinomas compared to other neuroendocrine tumors, it is important to obtain a complete clinical history and maintain a high index of suspicion in order to make a correct diagnosis of pituitary carcinoma on FNA.

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Cytomorphology of metastatic pituitary carcinoma to the bone

Chandler

Lin

2017

Diagnostic Cytopathology

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Metastatic pituitary carcinoma to bone is rare. In this report, we present a case of a 59-year-old female with recurrent pituitary adenoma of the sparsely granulated somatotroph subtype with metastasis to a few bony sites 10 years later. Needle core biopsy (NCB) with touch preparations was performed on a 5 mm lesion in left ilium. Diff-Quik stained NCB touch preparation slides showed a few loosely cohesive epithelial polygonal cells that were arranged in nests or acini, or singly, had scant vacuolated cytoplasm and eccentrically located round nuclei (plasmacytoid) with slight nuclear pleomorphism, fine granular chromatin, conspicuous nucleoli, and smooth nuclear membrane. Trilineage hematopoietic cells of bone marrow were also appreciated in the background. H&E stained core sections showed fragments of bone and bone marrow with nests of bland epithelial cells with similar cytomorphology as seen in NCB touch preparation slides. The tumor cells were immunoreactive for juxtanuclear dot-like staining of pan-cytokeratin (CAM 5.2 and AE1/AE3) (a specific feature), neuroendocrine markers (CD56, synaptophysin, and chromogranin. Additionally, scattered cells were immunoreactive for growth hormone. Molecular test showed that tumor cells were negative for the promoter methylation of O-6-Methylguanine-DNA Methyltransferase (MGMT). Final diagnosis of metastatic pituitary carcinoma was rendered. Morphology of metastatic pituitary carcinoma, its differential, clinical presentation and treatment were discussed. Diagn. Cytopathol. 2017;45:645-650. © 2017 Wiley Periodicals, Inc.

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Cytopathologic Features of Pituitary Carcinoma with Cervical Vertebral Bone Metastasis

Cited by 11 publications

References 18 publications

Malignant pituitary corticotroph adenomas: report of two cases and a comprehensive review of the literature

Malignant pituitary corticotroph adenomas: report of two cases and a comprehensive review of the literature

Metastatic Pituitary Carcinoma to Cervical Lymph Node: Diagnosis by Fine Needle Aspiration and Review of the Literature

Cytomorphology of metastatic pituitary carcinoma to the bone

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