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Non-Functioning Pituitary Carcinoma

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Abstract

Null-cell carcinomas of the pituitary are extremely rare. We describe a 41-year-old woman with a large adenohypophyseal neoplasm presenting as a primary nonfunctioning tumor without pituitary insufficiency. Signs of mass effect with progressive unilateral ocular motility disorders and anterior pituitary failure developed rapidly. Histopathological examination of the trans-sphenoidally removed tumor showed a primary pituitary null cell tumor with high mitotic index. Pituitary carcinoma was suspected because of rapid relapse of ocular motility disorders and of intra-sellar tumor growth after surgery. Radiotherapy of the sellar and parasellar area with a total dose of 59.4 Gy was performed, achieving marked tumor reduction and a significant improvement of ocular motility disorders. However, 6.5 months after presentation the patient rapidly declined and died of carcinomatous meningitis.

Less than 100 pituitary carcinomas have been published so far, most of them as single-case reports, and endocrine, immunohistochemical, and ultrastructural data have not been described in the majority of cases. At presentation, there are no specific symptoms that allow to distinguish benign from malignant tumor. Prognosis is poor, since no curative treatment has been established, but aggressive surgery and radiotherapy has been recommended. Our case highlights the poor prognosis of nonfunctioning pituitary carcinomas.

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References

  1. Pernicone PJ, Scheithauer BW, Sebo TJ, Kovacs KT, Horvath E, Young WF Jr, Lloyd RV, Davis DH, Guthrie BL, Schoene WC. Pituitary carcinoma: A clinicopathological study of 15 cases. Cancer 1997;79:804–812.

    Article  CAS  PubMed  Google Scholar 

  2. Selman WR, Laws ER Jr, Scheithauer BW, Carpenter SM. The occurrence of dural invasion in pituitary adenomas. J Neurosurg 1986;64:402–407.

    Article  CAS  PubMed  Google Scholar 

  3. Scheithauer BW, Fereidooni F, Horvath E, Kovacs K, Robbins P, Tews D, Henry K, Pernicone P, Gaffey TA Jr, Meyer FB, Young WF Jr, Fahlbusch R, Buchfelder M, Lloyd RV. Pituitary carcinoma: An ultrastructural study of eleven cases. Ultrastruct Pathol 2001;25:227–242.

    Article  CAS  PubMed  Google Scholar 

  4. Thapar K, Kovacs K, Scheithauer BW, Stefaneanu L, Horvath E, Pernicone PJ, Murray D, Laws ER Jr. Proliferative activity and invasiveness among pituitary adenomas and carcinomas: An analysis using the MIB-1 antibody. Neurosurgery 1996;38:99–107.

    Article  CAS  PubMed  Google Scholar 

  5. Thapar K, Yamada Y, Scheithauer BW, Kovacs K, Yamada S, Stefaneanu L. Assessment of mitotic activity in pituitary adenomas and carcinomas. End Pathol 1996;7:215–221.

    Article  Google Scholar 

  6. Thapar K, Scheithauer BW, Kovacs K, Pernicone PJ, Laws ER Jr. p53 expression in pituitary adenomas and carcinomas: Correlation with invasiveness and tumor growth fractions. Neurosurgery 1996;38:765–771.

    Article  CAS  PubMed  Google Scholar 

  7. Scheithauer BW, Kovacs K, Horvath E, Lloyd RV. In: Solcia E, Kloppel G, Sobin LE, eds. Tumors of the adenohypophysis: Histological Typing of Endocrine Tumors, 2nd ed, pp. 15–37. World Health Organisation. Berlin: Springer, 2000.

    Google Scholar 

  8. Giorgis B, Campiche R, Burckhardt P, Gomez F. Diagnostic, traitement et évolution des tumeurs hypophysaires: Etude rétrospective de 123 cas. Schweizerische Medizinische Wochenschrift 1986;116:1431–1440.

    CAS  PubMed  Google Scholar 

  9. Gsponer J, de Tribolet N, Déruaz JP, Janzer R, Uské A, Mirimanoff RO, Reymond MJ, Rey F, Temler E, Gaillard RC, Gomez F. Diagnosis, treatment, and outcome of pituitary tumors and other abnormal intrasellar masses. Retrospective analysis of 353 patients. Medicine (Baltimore) 1999;78:236–269.

    Article  CAS  Google Scholar 

  10. Spertini F, Deruaz JP, Perentes E, Pelet B, Gomez F. Luteinizing hormone (LH)-and prolactin (PRL)-pituitary tumor: Possible malignant transformation of the LH cell line. J Clin Endocrinol Metabol 1986;62:849–854.

    Article  CAS  Google Scholar 

  11. Kaltsas GA, Mukherjee JJ, Plowman PN, Monson JP, Grossman AB, Besser GM. The role of cytotoxic chemotherapy in the management of aggressive and malignant pituitary tumors. J Clin Endocrinol Metabol 1998;83:4233–4238.

    Article  CAS  Google Scholar 

  12. Doniach I. Pituitary carcinoma. In: Sheaves R, Jenkins PJ, Wass JAH, eds. Clinical Endocrine Oncology, pp 225–227. Oxford: Blackwell Science Ldt., 1997.

    Google Scholar 

  13. Max MB, Deck MD, Rottenberg DA. Pituitary metastasis: Incidence in cancer patients and clinical differentiation from pituitary adenoma. Neurology 1981;31:998–1002.

    Article  CAS  PubMed  Google Scholar 

  14. Landman RE, Horwith M, Peterson RE, Khandji AG, Wardlaw SL. Long-term survival with ACTH-secreting carcinoma of the pituitary: A case report and review of the literature. J Clin Endocrinol Metabol 2002;87:3084–3089.

    Article  CAS  Google Scholar 

  15. Kemink SAG, Wesseling P, Pieters GFFM, Verhofstad AAJ, Hermus ARMM, Smals AGH. Progression of a Nelson's adenoma to pituitary carcinoma: A case report and review of the literature. J Endocrinol Invest 1999;22:70–75.

    Article  CAS  PubMed  Google Scholar 

  16. Mountcastle RB, Roof BS, Mayfield RK, Mordes BD, Sagel J, Biggs PJ, Rawe SE. Case report: Pituitary adenocarcinoma in an acromegalic patient: Response to bromocriptine and pituitary testing: A review of the literature on 36 cases of pituitary carcinoma. Am J Med Sci 1989;298:109–118.

    Article  CAS  PubMed  Google Scholar 

  17. Frost AR, Tenner S, Tenner M, Rollhauser C, Tabbara SO. ACTH-producing pituitary carcinoma presenting as the cauda equina syndrome. Arch Pathol Lab Med 1995;119:93–96.

    CAS  PubMed  Google Scholar 

  18. Cartwright DM, Miller TR, Nasr AJ. Fine-needle aspiration biopsy of pituitary carcinoma with cervical lymph node metastases: A report of two cases and review of the literature. Diagnostic Cytopathol 1994;11:68–73.

    Article  CAS  Google Scholar 

  19. Scheithauer BW, Randall RV, Laws ER Jr, Kovacs KT, Horvath E, Whitaker MD. Prolactin cell carcinoma of the pituitary: Clinicopathologic, immunohistochemical and ultrastructural study of a case with cranial and extracranial metastases. Cancer 1985;55:598–604.

    Article  CAS  PubMed  Google Scholar 

  20. Kaltsas GA, Grossman AB. Malignant pituitary tumours. Pituitary 1998;1:69–81.

    Article  CAS  PubMed  Google Scholar 

  21. Wilson DF. Pituitary carcinoma occurring as middle ear tumor. Otolaryngol Head and Neck Surg 1982;90:665–666.

    Article  CAS  Google Scholar 

  22. George DH, Scheithauer BW, Kovacs K, Horvath E, Young WF, Lloyd RV, Meyer FB. Crooke's cell adenoma of the pituitary: an aggressive variant of corticotroph adenoma. Am J Surg Pathol 2003;27:1330–1336.

    Article  PubMed  Google Scholar 

  23. Roncaroli F, Scheithauer BW, Young WF, Horvarth E, Kovacs K, Kros JM, Al-Sarraj S, Lloyd RV, Faustini-Fustini M. Silent corticotroph carcinoma of the adenohypophysis: A report of five cases. Am J Surg Pathol 2003;27:477–486.

    Article  PubMed  Google Scholar 

  24. McCutcheon IE, Pieper DR, Fuller GN, Benjamin RS, Friend KE, Gagel RF. Pituitary carcinoma containing gonadotrophins: Treatment by radical excision and cytotoxic chemotherapy: Case report. Neurosurgery 2000;46:1233–1240.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Service of Endocrinology, Diabetology and Metabolism, Department of Internal Medicine, University Hospital, Lausanne, Switzerland

    Petra Nadja Elsässer Imboden & Fulgencio Gomez

  2. Department of Ophthalmology, Hôpital Ophtalmique Jules-Gonin, Lausanne, Switzerland

    François-Xavier Borruat

  3. Department of Neurosurgery, University Hospital, Lausanne, Switzerland

    Nicolas De Tribolet

  4. Department of Pathology, University Hospital, Lausanne, Switzerland

    Kathleen Meagher-Villemure

  5. Service of Radio-Oncology, University Hospital, Lausanne, Switzerland

    Alesia Pica

  6. Service of Endocrinology, Diabetology and Metabolism, Department of Internal Medicine, BH-10, University Hospital-CHUV, CH-1011, Lausanne, Switzerland

    Fulgencio Gomez

Authors
  1. Petra Nadja Elsässer Imboden
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  2. François-Xavier Borruat
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  3. Nicolas De Tribolet
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  4. Kathleen Meagher-Villemure
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  5. Alesia Pica
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  6. Fulgencio Gomez
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Correspondence to Fulgencio Gomez.

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Imboden, P.N.E., Borruat, FX., De Tribolet, N. et al. Non-Functioning Pituitary Carcinoma. Pituitary 7, 149–156 (2004). https://doi.org/10.1007/s11102-005-3411-3

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  • DOI: https://doi.org/10.1007/s11102-005-3411-3

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