Malignant Glioma of the Optic Chiasm Eight Years After Radiotherapy for Prolactinoma

Hufnagel, Thierry J.; Kim, Jung Ho; Lesser, Robert L.; Miller, Joseph M.; Abrahams, James J.; Piepmeier, Joseph M.; Manuelidis, Elias E.

doi:10.1001/archopht.1988.01060140873031

Cited by 40 publications

(7 citation statements)

References 24 publications

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“…Until now, 44 cases have been described, not including the present case [1,3,4,5,6,7,9,10,11,12,13,14,15,16,17,18,20,22,23,25,26,27,28,29]. They are summarised in Table 1.…”

Section: Discussionsupporting

confidence: 49%

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Unilateral adult malignant optic nerve glioma

Wabbels

Demmler

Seitz

et al. 2004

Graefe's Arch Clin Exp Ophthalmol

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Unilateral adult malignant glioma of the optic nerve is exceptional. The final diagnosis was only confirmed by optic nerve biopsy. In the literature, only one patient has been reported with a unilateral tumour manifestation; he was lost to follow-up 3 months later. All other cases were bilateral. To date, 44 case reports of adult malignant optic nerve glioma have been published, either malignant astrocytoma or glioblastoma. These tumours can mimic optic neuritis in their initial presentation. The diagnosis is seldom made before craniotomy. On MRI images, malignant glioma cannot be distinguished from optic nerve enlargement due to other causes. Although radiotherapy appears to prolong life expectancy, all presently available treatment options (radiation, surgery, radio-chemotherapy) are of limited value. Most patients go blind and die within 1 or 2 years.

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“…Until now, 44 cases have been described, not including the present case [1,3,4,5,6,7,9,10,11,12,13,14,15,16,17,18,20,22,23,25,26,27,28,29]. They are summarised in Table 1.…”

Section: Discussionsupporting

confidence: 49%

“…Only one case of adult malignant optic nerve glioma developed 8 years after radiotherapy for a recurrent prolactinoma [13]. In all other cases, no radiotherapy or other potentially tumour-promoting events were noted.…”

Section: Discussionsupporting

confidence: 41%

Unilateral adult malignant optic nerve glioma

Wabbels

Demmler

Seitz

et al. 2004

Graefe's Arch Clin Exp Ophthalmol

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“…It is known that irradiation of the pituitary fossa may induce the development of a sellar or parasellar tumour of non-pituitary origin, such as an osteogenic sarcoma (6), fibrosarcoma (7,8) or glioma (9). Apart from such radiation oncogenesis, it is commonly held that most, if not all, recurrent pi¬ tuitary tumours are expected to show the same histopathological and endocrine features as did the original tumours.…”

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confidence: 42%

A null cell adenoma of the pituitary detected seven years after removal of a prolactinoma. Recurrence or de novo tumourigenesis?

Watanobe

Kudo²,

Okushima³

et al. 1991

Acta Endocrinologica

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We report an extremely unusual case of prolactinoma which emerged at recurrence as a null cell adenoma. A 53-year-old woman sought medical attention for progressive visual loss and headache. A pituitary tumour was detected by a computed tomographic scan, and hyperprolactinemia was noted. The tumour, removed by a transfrontal surgery, was a chromophobe adenoma, and immunohistochemically the adenoma cells were selectively positive for PRL, which indicated a prolactinoma. Postoperatively, her plasma PRL level was normalized. Seven years later, she noted blurred vision and again sought medical attention. A CT scan demonstrated recurrence of a pituitary tumour. On this occasion, however, she was not hyperprolactinemic. She underwent again a transfrontal resection of the pituitary tumour. Its histology was again a chromophobe adenoma, but the adenoma cells showed no positive immunostaining for any anterior pituitary hormone including PRL, which indicated a null cell adenoma. We have no clear explanation of the pathogenesis underlying her very unusual course. However, null cells (assuming that the original tumour was a mixed adenoma) left behind at the first surgery, or unidentified hypothalamic and/or pituitary derangements might possibly have been responsible for the recurrence. We learned from this patient that recurrent pituitary adenomas may not necessarily have the same endocrine features as did the original tumours. This information appears to make a valid clinical point, because if hormone levels alone are followed after pituitary surgery, recurrent pituitary tumours may be overlooked.Pituitary tumours may recur, mostly within the first 10 years after the initial treatment (1-5). Recur¬ rence rate following surgery alone has been re¬ ported to be 16-30% (1-3); a combined surgery and radiation therapy reduces the rate to 3-15% (1-5).It is known that irradiation of the pituitary fossa may induce the development of a sellar or parasellar tumour of non-pituitary origin, such as an osteogenic sarcoma (6), fibrosarcoma (7,8) or glioma (9). Apart from such radiation oncogenesis, it is commonly held that most, if not all, recurrent pi¬ tuitary tumours are expected to show the same histopathological and endocrine features as did the original tumours. This observation is clinically im¬ portant in the follow-up of patients with function¬ ing pituitary tumours, because re-increases in hor¬ mone levels may suggest tumour regrowth.In this context, a previous case report by Teramoto et al. (10) appears extremely unusual. Their patient was initially diagnosed to harbour a GHproducing adenoma and was operated on, but 7.5 years later it recurred as a null cell adenoma. Re¬ cently, we have experienced a similar case of pitu¬ itary tumour. Our patient was initially diagnosed to have a prolactinoma and operated on, but it re¬ curred 7 years later as a null cell adenoma. We attempted to explain the pathogenesis of this un¬ usual transformation. MethodsHormone assays Determinations of PRL, LH, FSH, TSH, ACTH, GH, cortisol and IGF-I w...

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“…After articles were excluded based on our present inclusion and exclusion criteria, finally 87 articles with a total of 137 (48 neuroepithelial tumors, 37 meningiomas, 52 sarcomas) patients in the 1959–2017 period were included in this review, although data is missing regarding overall survival and type of irradiation in a significant proportion of the reports (Figure 1, Table 1, Supplementary Table S1) [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,…”

Section: Resultsmentioning

confidence: 99%

Secondary Intracranial Tumors Following Radiotherapy for Pituitary Adenomas: A Systematic Review

Yamanaka

Abe

Toshihiko³

et al. 2017

Cancers

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Pituitary adenomas are often treated with radiotherapy for the management of tumor progression or recurrence. Despite the improvement in cure rates, patients treated by radiotherapy are at risk of development of secondary malignancies. We conducted a comprehensive literature review of the secondary intracranial tumors that occurred following radiotherapy to pituitary adenomas to obtain clinicopathological characteristics. The analysis included 48 neuroepithelial tumors, 37 meningiomas, and 52 sarcomas which were published between 1959–2017, although data is missing regarding overall survival and type of irradiation in a significant proportion of the reports. The average onset age for the pituitary adenoma was 37.2 ± 14.4 years and the average latency period before the diagnosis of the secondary tumor was 15.2 ± 8.7 years. Radiotherapy was administered in pituitary adenomas at an average dose of 52.0 ± 19.5 Gy. The distribution of pituitary adenomas according to their function was prolactinoma in 10 (7.2%) cases, acromegaly in 37 (27.0%) cases, Cushing disease in 4 (2.9%) cases, PRL+GH in 1 (0.7%) case, non-functioning adenoma in 57 (41.6%) cases. Irradiation technique delivered was lateral opposing field in 23 (16.7%) cases, 3 or 4 field technique in 27 (19.6%) cases, rotation technique in 10 (7.2%) cases, radio surgery in 6 (4.3%) cases. Most of the glioma or sarcoma had been generated after lateral opposing field or 3/4 field technique. Fibrosarcomas were predominant before 1979 (p < 0.0001). The median overall survival time for all neuroepithelial tumors was 11 months (95% confidence intervals (CI), 3–14). Patients with gliomas treated with radiotherapy exhibited a non-significant positive trend with longer overall survival. The median overall survival time for sarcoma cases was 6 months (95% CI, 1.5–9). The median survival time in patients with radiation and/or chemotherapy for sarcomas exhibited a non-significant positive trend with longer overall survival. In patients treated with radiotherapy for pituitary adenomas, the risk of secondary tumor incidence warrants a longer follow up period. Moreover, radiation and/or chemotherapy should be considered in cases of secondary glioma or sarcoma following radiotherapy to the pituitary adenomas.

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Malignant Glioma of the Optic Chiasm Eight Years After Radiotherapy for Prolactinoma

Cited by 40 publications

References 24 publications

Unilateral adult malignant optic nerve glioma

Unilateral adult malignant optic nerve glioma

A null cell adenoma of the pituitary detected seven years after removal of a prolactinoma. Recurrence or de novo tumourigenesis?

Secondary Intracranial Tumors Following Radiotherapy for Pituitary Adenomas: A Systematic Review

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