Early and isolated breast cancer metastasis to the pituitary: A case report and systematic review

Abstract

Background: Pituitary metastases (PMs) arising from breast cancer tend to occur many years following initial diagnosis, and after other systemic metastasis have been identified. Survival is generally considered to be poor. However, there are cases where patients present with an isolated metastatic lesion in the pituitary. Survival in this subset of patients has not been evaluated. We present a case of isolated PM that presented two years after initial diagnosis of breast cancer. We performed a systematic review of 38 breast cancer patients with PM. We report presentation, treatment strategy, and outcomes of breast cancer metastasis to the pituitary and highlight cases of isolated PM. Case Description: A 39 year old female presented with complaints of headache and polydipsia two years after diagnosis with breast cancer. Systemic workup was unremarkable, but brain imaging identified an isolated PM. Transsphenoidal debulking was performed with adjuvant radiation therapy (RT) targeted to the sellar region. Unfortunately, she passed away 9 months later from systemic progression. Conclusion: A total of 38 patients were included systematic review. Of these, 13 had isolated PM. Prevalent signs/ symptoms included visual disturbance, diabetes insipidus (DI), and hypothalamic dysfunction. Patients treated with surgical resection and adjuvant chemotherapy (ChT), or RT had better survival than those treated with resection alone. Patients that receive treatment for isolated PM may survive for many years without progression or recurrence.

Pituitary Metastasis Clinical Presentation of Diabetes Insipidus Six Years after Invasive Breast Carcinoma Diagnosis: Case Report

“…Pituitary metastases (PM) most commonly arise from breast cancer. In a recent systematic review of the literature with 32 studies and 38 patients, 62% of those with PM had diabetes insipidus as clinical manifestation 11 . For comparative purposes, a total of 41 (100%) reported cases of PM in women were compiled from the literature, with mean age of 58.8 ± 4.8 (range 30-91) years, mean time from primary diagnosis and metastasis of 6.8 ± 2.7 years and 35 (85.3%) cases (available data) of hormonal dysfunction (LH -luteinizing hormone, FSH -folliclestimulating hormone, TSH -thyroid-stimulating hormone, Prolactin and/or GH -growth hormone) including those from the aforementioned systematic review conducted by Rasiah et al [11][12][13][14] .…”

“…On average, approximately 65% of the patients with PM have had other early metastatic lesions, bone metastasis being the most common. The time interval between breast carcinoma diagnosis and PM is 5 to 7 years 11 .…”

“…Hormonal IHC markers such as ACTH, GH, Prolactin, TSH, FSH and LH, hormones produced in the pituitary gland tend to indicate this site as the origin of the lesion 16,17 . Approximately 30% of the cases evolve to death in an average time of seven months after the diagnosis of PM 11 .…”

“…Some tumor characteristics, as well as patient performance status, can be challenging to complete surgical resection 5,17 . Recently, it is being observed that those who underwent adjuvant therapies (chemotherapy or chemotherapy in association with radiotherapy) had better survival rate than patients who undergo single surgical resection 11 .…”

Neuro-ophthalmological findings of pituitary metastasis: Case series from a single center and review of the literature

“…The cases without detailed neuro-ophthalmological examinations. Forty-four cases from 38 papers reported the presenting neuro-ophthalmological symptoms, such as visual field defects, vision loss, diplopia, and ophthalmoplegia, were selected [ 1 , 2 , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] ]. The patient information, including age, sex, the time elapsed from primary cancer to the diagnosis of PM, sites of metastasis, treatment, and survival time after diagnosis of PM, were collected ( Supplementary material ).…”