Prolactin-producing pituitary carcinoma with pulmonary metastases

Abstract

Pituitary adenomas rarely are metastatic. Extracranial visceral metastases of prolactinomas were not previously reported. The authors report a case of a 34‐year‐old man with a prolactin‐producing pituitary carcinoma and histologically proven lung metastases. Pathologic examination of the pulmonary spread included electron microscopy and immunohistochemistry; these confirmed prolactin production by the tumor. The patient's presentation at initial diagnosis, disease recurrence, clinical course, management and response to therapy (with its theoretic basis) are detailed. Despite the use of dopamine analogues (to tolerance and in combination), there was documented intracranial and extracranial disease progression. Possible future therapeutic maneuvers are discussed.

Malignant prolactinoma: case report and review of the literature

“…At presentation, 71% of the patients had symptoms of local compression, such as headache and bitemporal hemianopsia. Only five other patients presented with ptosis (27,40), diplopia (34), oculomotor paresis (17), or lateral rectus paresis (13). Diabetes insipidus was a feature in only one patient (12).…”

“…Extracranial metastases within the central nervous system involved the spinal cord (8, 11, 13, 14, 17, 26, 27, 29, 30-33, 35, 38, 39). Approximately 40% of the malignant prolactinomas were associated with systemic metastases in bone (10,16,21,29,32,35,37), lymph nodes (18,21,28,29,31,37), lung (13,16,21,31,37), liver (21,25,31,36), and, rarely, ovaries (24,29).…”

Malignant Prolactinoma Discovered by D2 Receptor Imaging

“…These tumors are very rare, and a review of the literature only reveals 96 cases (for 2 recent reviews, see Refs. 1 and 2), which included 28 malignant prolactinomas (1,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), 25 ACTH-producing carcinomas, 12 GH-producing carcinomas, 1 TSH-producing carcinoma, and 30 gonadotropin-producing or clinically nonfunctioning carcinomas (2). At the University Hospital of Liege, this was the first pituitary carcinoma among 1200 pituitary tumors.…”

“…Distant metastases are rare. However, they have been reported in the skeleton in two cases (1,3), in lymph nodes in four cases (1,12,18), in the lung in two cases (11,13), and in the liver or ovaries in three cases (1,11,16). Some researchers suggest that metastases may have been grafted by surgery because they have been found on the surgical route in some cases (16).…”

Cabergoline in prolactinomas

“…17,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Although the diagnosis has not yet been established by a biopsy of the temporal lobe lesion, the positive p53 (see below), the secondary nonresponse to BRC, and the occurrence of a second lesion fluctuating in size with PRL levels are highly suggestive of malignancy. Since histology of the primary tumor is unreliable, pituitary tissue markers have recently become available that are helpful in predicting an adenoma's potential for recurrence and invasive or malignant behavior.…”