Pituitary carcinoma recurrent to the lumbar intradural extramedullary space: Case report

Arnold, Paul M.; Ratnasingam, Denesh; O’Neil, Maura; Johnson, Philip L.

doi:10.1179/2045772311y.0000000055

Cited by 14 publications

(6 citation statements)

References 16 publications

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“…Furthermore, it is unclear preoperatively which types of metastases will be amenable to complete resection. In some case reports, tumor resection was reported as en block [14,19,21,27,28], whereas others convey adherence of the tumor to neural elements precluding subtotal resection [7,10,18,20,22,23,26]. Our case was consistent with the latter-intimately associated with the intradural rootlets of the cauda equina.…”

Section: Surgical Considerationssupporting

confidence: 80%

Intradural extramedullary metastasis: a review of literature and case report

Land

Bowden

Morpeth

et al. 2019

Spinal Cord Ser Cases

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Introduction Intradural extramedullary (IDEM) metastatic disease is infrequently encountered by spine surgeons and consequently poorly understood. Discovery often corresponds with the onset of neurologic symptoms and no consensus exists regarding the importance of complete resection or anticipated postoperative outcome. We aim to elucidate treatment methodologies that exist in the literature. Case presentation We present a unique case of a 57-year-old male with a known history of esophageal adenocarcinoma, including brain and visceral metastases, who presented with cauda equina syndrome. An IDEM metastatic esophageal adenocarcinoma lesion was identified on advanced imaging and biopsy. This was treated operatively without return of neurologic function. Discussion We reviewed and summarized the existing literature. Trends are highlighted to further guide surgeons treating this unusual metastatic phenomenon. Conclusion Intradural metastasis is a harbinger of advanced disease with a poor prognosis regardless of the etiology of the primary lesion. There are a number of proposed mechanisms for metastatic spread with little available literature for surgeon guidance. Most authors are advocates of a palliative, decompressive approach.

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Section: Surgical Considerationssupporting

confidence: 80%

Intradural extramedullary metastasis: a review of literature and case report

Land

Bowden

Morpeth

et al. 2019

Spinal Cord Ser Cases

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“…Regarding malignant pituitary tumors treated with TMZ, 24 case reports of PC and 27 case reports of APA were reported in the literature from 2006 to 2012. 23 – 49) TMZ was administered mainly according to the standard therapeutic dose of 150–200 mg/m 2 daily for 5 of every 28 days as one cycle. 50) In these reports, TMZ was effective in 36 cases (71%) and ineffective in 15 cases (29%).…”

Section: Tmz Treatment For Pc and Apamentioning

confidence: 99%

Treatment of Pituitary Carcinomas and Atypical Pituitary Adenomas: A Review

Hirohata

Ishii

Matsuno

2014

Neurol. Med. Chir.(Tokyo)

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Atypical pituitary adenomas (APAs) are aggressive tumors, harboring a Ki-67 (MIB-1) staining index of 3% or more, and positive immunohistochemical staining for p53 protein, according to the World Health Organization (WHO) classification in 2004. Pituitary carcinomas (PC) usually develop from progressive APAs and predominantly consist of hormone-generating tumors, defined by the presence of disseminations in the cerebrospinal system or systemic metastases. Most of the cases with these malignant pituitary adenomas underwent surgeries, irradiations and adjuvant medical treatments, nevertheless, the therapies are mainly palliative. Recently, the efficacy of temozolomide (TMZ), an orally administered alkylating agent, has been reported as an alternative medical treatment. However, some recent studies have demonstrated a significant recurrence rate after effective response to TMZ. Further clinical and pathological researches of malignant pituitary adenomas will be required to improve the outcome of patients with these tumors.

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“…Usually, a cervical or lumbar laminectomy are required. The principles of surgical treatment of intradural spinal tumors are applied [29]. The size and extent of the metastases determines the surgical procedure (Fig.…”

Section: Resection Of Spinal Metastasismentioning

confidence: 99%

Surgical treatment of aggressive pituitary adenomas and pituitary carcinomas

Buchfelder

Schlaffer

2020

Rev Endocr Metab Disord

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Surgery of aggressive pituitary adenomas and pituitary carcinomas is part of the interdisciplinary management of these difficult to treat tumors. Invasion, giant size and unusual, asymmetric extent of these tumors frequently require modifications or extensions of the standard approaches for transsphenoidal and transcranial surgery. Frequently, only debulking procedures can be performed. In aggressive and hormone secreting adenomas, the remission rates achieved by surgery alone are relatively poor and adjuvant medical treatments or irradiation are needed. Safe resection of as much tumor as possible and symptomatic control is aimed at, rather than remission. Many procedures are required for rapid progression of lesions or recurrences, in order to extend the survival of the patients. Metastases of pituitary carcinomas within the cranial cavity or spine can be attacked. Since they can occur anywhere in the brain or spinal canal they require the entire battery of neurosurgical approaches. Unfortunately, in this group of pituitary tumors, the complication rates are higher than in primary operations of enclosed adenomas. The respective techniques with their facilities and limitations are reviewed in this article.

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Pituitary carcinoma recurrent to the lumbar intradural extramedullary space: Case report

Abstract: In this unusual case, this pituitary carcinoma metastasized twice in 6 years to virtually the same intradural extramedullary lumbar region. Surgical resection of these masses aided in relieving neurological symptoms and prolonging life.

Cited by 14 publications

References 16 publications

Intradural extramedullary metastasis: a review of literature and case report

Intradural extramedullary metastasis: a review of literature and case report

Treatment of Pituitary Carcinomas and Atypical Pituitary Adenomas: A Review

Surgical treatment of aggressive pituitary adenomas and pituitary carcinomas

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