Progressive visual disturbance and enlarging prolactinoma caused by melanoma metastasis

Yang, Cong; Liu, Ling; Lan, Xiaoqiang; Zhang, Shiqiang; Li, Xinyu; Zhang, Bo

doi:10.1097/md.0000000000006483

Cited by 23 publications

(11 citation statements)

References 36 publications

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“…Only three prior cases have described a melanoma metastasis to a PA (Table 1). 12,13,25 In all three cases, patients reported progressive vision loss, and pituitary apoplexy was suspected in two. Common presentations included hyperprolactinemia and headache.…”

Section: Discussion Observationsmentioning

confidence: 95%

“…4 Despite the propensity for melanoma to metastasize to the brain, there are few reported cases of metastasis to the sellar region. [5][6][7][8][9][10][11] There are even fewer reported cases of a melanoma metastasis to a PA. 12,13 Although subtle differences exist on magnetic resonance imaging (MRI) between PAs and melanoma based on the presence of melanin, which typically exhibits a T1 hyperintense signal versus a T1 isointense signal in PAs, 14,15 the two pathologies remain difficult to differentiate on routine neuroimaging studies.…”

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confidence: 99%

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Melanoma metastasis to a nonfunctioning pituitary macroadenoma: illustrative case

Lamorie‐Foote¹,

Rangwala²,

Kammen³

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Metastases to the central nervous system are often multiple in number and typically favor the gray-white matter junction. Collision tumors, defined as the coexistence of two morphologically different tumors, such as metastases to a known pituitary adenoma (PA), are exceedingly rare. Only a few reported cases of metastases to a PA exist in the literature. OBSERVATIONS The authors present the case of a 64-year-old man with a known history of stage IV metastatic melanoma who was found to have hypermetabolic activity in the sellar region on surveillance positron emission tomography. On laboratory evaluation, he had clear evidence of pituitary axis dysfunction without diabetes insipidus. Subsequent magnetic resonance imaging showed a 2.4-cm sellar mass with features of a pituitary macroadenoma and internal hemorrhage, although no clinical symptoms of apoplexy were noted. He underwent a transsphenoidal endoscopic endonasal approach for resection of the sellar lesion. Final pathology showed a collision tumor with melanoma cells intermixed with PA cells. LESSONS Histological analysis verified the rare presence of a collision tumor of a melanoma metastasis to a nonfunctional pituitary macroadenoma. Metastasis to a preexisting PA, although rare, should be considered in the differential diagnosis in patients with sellar lesions and a known cancer history.

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Section: Discussion Observationsmentioning

confidence: 95%

mentioning

confidence: 99%

Melanoma metastasis to a nonfunctioning pituitary macroadenoma: illustrative case

Lamorie‐Foote¹,

Rangwala²,

Kammen³

et al. 2021

Journal of Neurosurgery: Case Lessons

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“…Table 1 summarizes the clinical features, onset symptoms, MRI, treatment, and outcomes of all patients with melanoma pituitary metastasis reported in literature to date. Cases of primary melanoma of the sellar region (16) and metastasis on preexisting pituitary mass (adenoma or oncocytoma) (17,18) have been excluded from our analysis.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Pituitary Melanoma Metastasis: A Dramatic and Prolonged Response to Dabrafenib-Trametinib Therapy

et al. 2020

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Introduction: Pituitary metastases (PM) are rare events and to date only very few cases of melanoma PM have been described in literature up to now. Case Presentation: We describe the clinical history of a 33-year-old male patient who underwent surgical excision of an inter-scapular melanoma in 2008. The subsequent follow-up was negative for ∼10 years. In September 2018, due to the onset of a severe headache, the patient underwent a brain magnetic resonance imaging, which showed an expansive mass in the saddle and suprasellar region with a maximum diameter of 17 mm. Pituitary function tests and visual field were normal. Worsening of the headache and the appearance of a left eye ptosis led the patient to surgical removal of the lesion in October 2018. The histological examination unexpectedly showed metastasis of the melanoma. Post-operative hormonal assessment showed secondary hypothyroidism and hypoadrenalism, which were both promptly treated, and a mild hypogonadism. Three months after surgery, a sellar MRI showed a persistent, increased pituitary mass (3 cm of diameter); fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) detected an increased radiopharmaceutical uptake in the sellar region. Due to the persistence of the disease and the evidence of a BRAF V600E mutation, in February 2019, the patient underwent a combined treatment with dabrafenib (a BRAF inhibitor) and trametinib (mitogen-activated extracellular signal-regulate kinase inhibitor). Sellar MRI performed 6 months later showed no evidence of mass in the sellar region. The patient was in a good clinical condition and did not complain of headaches or other symptoms; there were no significant side-effects from the anticancer therapy. After 13 months of treatment, the patient showed no recurrence of the disease on morphological imaging. Anticancer therapy was confirmed, replacement therapies with hydrocortisone and levothyroxine continued and the pituitary-gonadal axis was restored. Mormando et al. Dabrafenib-Trametinib in Pituitary Melanoma Metastasis Conclusion: This is a very interesting case, both for the rarity of the pituitary melanoma metastasis and for the singular therapeutic course carried out by the patient. This is the first case of a pituitary melanoma metastasis with BRAF mutation, successfully treated with the combination of dabrafenib and trametinib after incomplete surgical removal.

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“…There is evidence that it is corresponding to the increased level of POMC in pituitary adenoma relative to the normal pituitary. The effect of POMC on alpha-melanocyte stimulating hormone leads to the regulation of melanin production ( 21 ). As indicated in our study, there is a chance that some of the central nodes are not among the query ones ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

Human Prolactinoma: A View of Protein-Protein Interaction Pattern

Azodi

Rezaei-Tavirani

Nejad

et al. 2018

Int J Endocrinol Metab

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The aim of this study was to identify the highly expressed genes in terms of interaction concept in Prolactinoma. The study was conducted by additional analysis of the available data from the GEO database. The online tool, GEO2R, was used to analyze the gene expression profile of GSE36314 dataset using the GPL8300 platform. Consequently, a PPI network of up-regulated and down-regulated genes was constructed and examined to introduce the possible targets with possible therapeutic values. A number of 46 genes were dysregulated in Prolactinoma and their network indicated 15 essential genes via topological analysis. Moreover, the present study found that the highlighted genes of prolactinoma are involved in two major biological processes including growth regulation and metabolic function. Thus, the determined genes may be valuable for diagnosis, treatment, and patient follow-up. However, further studies are essential to validate this conclusion.

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Progressive visual disturbance and enlarging prolactinoma caused by melanoma metastasis

Cited by 23 publications

References 36 publications

Melanoma metastasis to a nonfunctioning pituitary macroadenoma: illustrative case

Melanoma metastasis to a nonfunctioning pituitary macroadenoma: illustrative case

A Rare Case of Pituitary Melanoma Metastasis: A Dramatic and Prolonged Response to Dabrafenib-Trametinib Therapy

Human Prolactinoma: A View of Protein-Protein Interaction Pattern

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