Pituitary lesions in breast cancer patients: A report of three cases

Abstract

Abstract.Pituitary metastases occur in 6-8% of breast cancer cases, but are seldom diagnosed and rarely reported. Therefore, it can be challenging to establish a clinical differential diagnosis, and at present, a definitive criteria is not available. The present study discusses the pituitary lesions identified in three patients with breast cancer, and describes their management within the collaborative framework of the Breast Unit at the Città della Salute Hospital, which also included assessment by endocrinologists. The patients were evaluated for anterior and posterior pituitary function, the appearance of the pituitary upon magnetic resonance imaging (MRI), and the oncology status and treatment. In addition, successive analysis of prolactin levels and the MRI was performed. The patients, aged 75, 83 and 76 years old, differed in their clinical presentation and successive evolution. One patient demonstrated an abrupt onset of diabetes insipidus, the second exhibited overt hypopituitarism and the final patient had a pituitary mass discovered by chance. Cases one and three exhibited systemic spread of the breast cancer, with bone and/or parenchymal metastasis, but not brain metastasis. Case two presented with a secondary pituitary tumour alone. In case three, a secondary nature to the pituitary lesion was unlikely, since there was no lesion evolution evident following MRI and as stable prolactin levels were observed over the course of the study period. By contrast, case one presented with a rapid increase of sellar lesions on MRI, together with a progressive rise in prolactin levels. Taking into account the frailty of breast cancer patients who are monitored for disease progression, management in a collaborative framework, such as at the Breast Unit, makes it possible to establish a diagnosis of sellar lesions, which is adequate for the comprehensive management of the patient with successive pituitary MRIs and prolactin evaluations, and avoids unnecessary invasive neurosurgery. IntroductionIn breast cancer patients, the development of metastatic disease is considered to be the major cause of mortality (1). The invasion-metastasis cascade is a multistep process in which breast cancer cells invade the systemic circulation and distant tissues, and cause the metastatic colonization of different organs, including the bones, lungs and central nervous system (2). Being highly vascularized, the pituitary gland is a target structure for metastatic spread, accounting for 0.14-28% of all reported brain metastases following autopsy (3). In total, 6-8% of breast cancer cases demonstrate metastatic spread to the pituitary gland (4). Despite this, pituitary metastases are seldom diagnosed and rarely described in surgical series, overall representing just 1% of surgically-resected tumours in the sellar region (5). The clinical differential diagnosis of benign lesions in the sellar region is challenging, and at present, a definitive clinical criteria is not available (6). The majority of patients may be asymptomatic, but the mos...

Metastatic breast cancer masquerading as a pituitary macroadenoma: A case report

“… 5 An extensive literature review yielded several reports of symptomatic breast cancer metastases to the pituitary; all of the patients in these cases presented with DI, anterior hypopituitarism, or both. 6 – 11 The patient reported in this case solely presented with signs and symptoms of mass effect, including headache, blurry vision, and dysfunction of the oculomotor nerve. Findings consistent with DI and hypopituitarism were absent.…”

Pituitary metastases from neuroendocrine neoplasms: case report and narrative review

“…PM are rare findings, even in patients with an advanced neoplastic disease. In general, approximately 5% of patients with a known history of malignancy are thought to have a latent PM [ 47 ], with the highest percentages in patients with breast cancer [ 1 , 48 , 49 ]. The abundant blood supply of the pituitary gland may facilitate hematogenic metastatic spreading and seeding [ 50 ].…”

Hypopituitarism secondary to a pituitary metastasis in a young woman with an invasive breast carcinoma

“…Pituitary metastases occur in 6%‐8% of breast cancer cases and usually affect elderly patients in the sixth or seventh decade of life 6 . The mean age at presentation is about 60 years 10 .…”

“…Their most common primary sources are breast and lung cancer 4 . They tend to affect elderly patients in the sixth or seventh decade of life, and they are more frequent in patients with disseminated systemic metastases 5,6 . The diagnosis and the treatment of pituitary metastases are challenging.…”