Pituitary Carcinoma Presenting with Multiple Metastases: Case Report

Güzel, Aslan; Tatlı, Mehmet; Şentürk, Senem; Güzel, Ebru; Çaylı, Süleyman; Sav, Aydın

doi:10.1177/0883073808319078

Cited by 33 publications

(21 citation statements)

References 11 publications

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“…Takeshita el al [40] intend to continue tri-monthly maintenance therapy of a Crooke cell carcinoma after 2 years of sustained response to temozolomide in both the primary tumor and liver metastases. Guzel et al reported a presumed case of a 9-year-old girl with a null cell carcinoma unresponsive to temozolomide who died after 2 months [3]. We excluded the latter case from the list of bona fide reported tumors in that (a) the primary tumor did not originally affect the sella, (b) S-100 protein staining was noted, (c) no pituitary hormone immunostaining was noted in an age group [8,14,35,41,42] wherein almost all [8,14,35,[41][42][43] (Table 2).…”

Section: Discussionmentioning

confidence: 97%

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MGMT immunoexpression in aggressive pituitary adenoma and carcinoma

et al. 2010

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Recent case reports have documented the efficacy of temozolomide therapy in some aggressive pituitary adenomas and pituitary carcinomas resistant to multimodality therapy. Evidence suggests that low O6-methylguanine-DNA methyltransferase (MGMT) immunoexpression correlates with response to temozolomide chemotherapy. Herein, we aimed to study MGMT immunoexpression in a spectrum of pituitary tumors, indolent, aggressive and malignant. A literature review of the use of temozolomide in pituitary tumors was also performed. Immunohistochemistry for MGMT was performed on 60 pituitary tumors identified in the Mayo Clinic Tissue Registry and the consultation files of one of us (BWS). The group included 30 pituitary carcinomas (15 ACTH, 10 PRL, 1 FSH/LH, 1 TSH, 1 silent subtype 3 and 2 null cell). Tissue from recurrences was available in 17 cases. In addition, 30 functionally different pituitary adenomas were studied, including 15 invasive and 15 non-invasive adenomas. Overall, 32 cases of pituitary tumors (54%) demonstrated low MGMT immunoexpression. This included 17 of 30 (57%) carcinomas, 9 of 15 (60%) invasive adenomas, and 6 of 15 cases (40%) of non-invasive pituitary adenomas. There was no significant change in MGMT immunoexpression between primary and recurrent tumors. Prolactin-producing carcinomas had the highest proportion of tumors (80%) with low expression. A significant proportion of pituitary adenomas and carcinomas demonstrate low MGMT immunoexpression. In an effort to anticipate the likelihood of a temozolomide response, all cases of aggressive pituitary tumors should be assessed for MGMT expression.

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Section: Discussionmentioning

confidence: 97%

“…Representing 0.2% of all pituitary neoplasms, fewer than 150 cases are reported in the English literature [1][2][3][4][5][6][7][8][9][10][11]. Their local invasiveness about vital structures and, by definition, craniospinal axis or systemic metastasis, represents diagnostic and therapeutic challenges [12].…”

Section: Introductionmentioning

confidence: 99%

MGMT immunoexpression in aggressive pituitary adenoma and carcinoma

et al. 2010

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“…Although assessment of proliferation may be helpful in arousing suspicion as to subsequent tumor invasiveness and/or malignant potential, growth rate is probably not the only major determinant of tumor behavior and carcinogenesis. [1241415]…”

Section: Discussionmentioning

confidence: 99%

“…[11] Although histologically “atypical PAs” do not necessarily behave clinically as “atypical”, a high index of suspicion for these lesions is currently recommended. [13815] It was also noted that there does not seem to be a significant correlation between Ki- 67 LI and tumor size of PA, even if this index is considered as a useful marker in the determination of the infiltrative behavior of these tumors. [11] Clinically, the name “atypical pituitary adenoma” is used to describe tumors that recur or progress despite resection and radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Pituitary carcinoma diagnosed on fine needle aspiration: Report of a case and review of pathogenesis

2010

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Pituitary carcinoma (PC) is a very rare entity (0.2% of all pituitary tumors), with only about 140 cases reported in English literature. There are no reliable histological, immunohistochemical or ultrastructural features distinguishing pituitary adenoma (PA) from PC. By definition, a diagnosis of PC is made after a patient with PA develops non-contiguous central nervous system (CNS) or systemic metastases. To date, only three cases of PC have been reportedly diagnosed on fine needle aspiration (FNA). Two of the reported cases were diagnosed on FNA of the cervical lymph nodes and one on FNA of the vertebral bone lesion. Herein, we present a case of PC, diagnosed on FNA of the liver lesion. In this case, we describe cytologic features of PC and compare them to histologic features of the tumor in the pituitary. Clinical behavior of tumor, pathogenesis of metastasis and immunochemical and prognostic markers will also be described.

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“…These tumours were null cell (n = 1) and Crooke cell carcinoma (n = 1) with multiple liver, intracranial and intraspinal metastases leading to patient death despite multiple treatments (169,174).…”

Section: Special Circumstances a Paediatricmentioning

confidence: 99%

European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

Raverot

Burman

McCormack

et al. 2018

European Journal of Endocrinology

482

583

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Background: Pituitary tumours are common and easily treated by surgery or medical treatment in most cases. However, a small subset of pituitary tumours does not respond to standard medical treatment and presents with multiple local recurrences (aggressive pituitary tumours) and in rare occasion with metastases (pituitary carcinoma). The present European Society of Endocrinology (ESE) guideline aims to provide clinical guidance on diagnosis, treatment and follow-up in aggressive pituitary tumours and carcinomas. Methods: We decided upfront, while acknowledging that literature on aggressive pituitary tumours and carcinomas is scarce, to systematically review the literature according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The review focused primarily on first-and second-line treatment in aggressive pituitary tumours and carcinomas. We included 14 single-arm cohort studies (total number of patients = 116) most on temozolomide treatment (n = 11 studies, total number of patients = 106). A positive treatment effect was seen in 47% (95% CI: 36-58%) of temozolomide treated. Data from the recently performed ESE survey on aggressive pituitary tumours and carcinomas (165 patients) were also used as backbone for the guideline. In patients responding to first-line temozolomide, we suggest continuing treatment for at least 6 months in total. Furthermore, the guideline offers recommendations for patients who recurred after temozolomide treatment, for those who did not respond to temozolomide and for patients with systemic metastasis.

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Pituitary Carcinoma Presenting with Multiple Metastases: Case Report

Cited by 33 publications

References 11 publications

MGMT immunoexpression in aggressive pituitary adenoma and carcinoma

MGMT immunoexpression in aggressive pituitary adenoma and carcinoma

Pituitary carcinoma diagnosed on fine needle aspiration: Report of a case and review of pathogenesis

European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

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