Abstract
The patient was a 70-year-old man with a recurrent pituitary tumor. Three surgeries were performed but the tumor recurred. Based on histologic, immunohistochemical and ultrastructural studies, the diagnosis of oncocytic gonadotrophic pituitary adenoma was made. The tumor was a macroadenoma partly immunopositive for LH. Immunohistochemistry for O6 Methylguanine-DNA Methyl-Transferase (MGMT) showed an admixture of immunopositive and immunonegative cells. After recurrence following operations, the patient was treated with Temozolomide, an imidazotetrazine derivative, DNA-alkylating drug. Following Temozolomide administration the MRI demonstrated significant tumor necrosis. A few months later, the patient died of massive pulmonary embolism. No autopsy was performed. The present case indicates that benign, typically slow-growing pituitary adenomas of oncocytic gonadotrophic type may respond to Temozolomide even when the tumor consists of an admixture of MGMT immunopositive and immunonegative cells.
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Newlands ES, Stevens MF, Wedge SR, Wheelhouse RT, Brock C, 1997 Temozolomide: A review of its discovery, chemical properties, pre-clinical development and clinical trials. Cancer Treat Rev 23: 35–61.
Agarwala SS, Kirkwood JM, 2000 Temozolomide, a novel alkylating agent with activity in the central nervous system, may improve the treatment of advanced metastatic melanoma. Oncologist 5: 144–151.
Stupp R, Gander M, Leyvraz S, Newlands E, 2001 Current and future developments in the use of temozolomide for the treatment of brain tumours. Lancet Oncol 2: 552–560.
Kulke MH, Stuart K, Enzinger PC, et al, 2006 Phase II study of temozolomide and thalidomide in patients with metastatic neuroendocrine tumors. J Clin Oncol 24: 401–406.
Fadul CE, Kominsky AL, Meyer LP, et al, 2006 Long-term response of pituitary carcinoma to temozolomide. Report of two cases. J Neurosurg 105: 621–626.
Lim S, Shahinian H, Maya MM, Yong W, Heaney AP, 2006 Temozolomide: A novel treatment for pituitary carcinoma. Lancet Oncol 7: 518–520.
Syro LV, Uribe H, Penagos LC, et al, 2006 Antitumour effects of temozolomide in a man with a large, invasive prolactin-producing pituitary neoplasm. Clin Endocrinol (Oxf) 65: 552–553.
Kovacs K, Horvath E, Syro LV, et al, 2007 Temozolomide therapy in a man with an aggressive prolactin-secreting pituitary neoplasm: Morphological findings. Hum Pathol 38: 185–189.
Neff LM, Weil M, Cole A, et al, 2007 Temozolomide in the treatment of an invasive prolactinoma resistant to dopamine agonists. Pituitary 10: 81–86.
Moyes VJ, Alusi G, Sabin HI, et al, 2009 Treatment of Nelson’s syndrome with temozolomide. Eur J Endocrinol 160: 115–119.
Widhalm G, Wolfsberger S, Preusser M, et al, 2009 O(6)-methylguanine DNA methyltransferase immunoexpression in nonfunctioning pituitary adenomas: Are progressive tumors potential candidates for temozolomide treatment? Cancer 115: 1070–1080.
Horvath E, Vidal S, Syro LV, Kovacs K, Smyth HS, Uribe H, 2001 Severe lymphocytic adenohypophysitis with selective disappearance of prolactin cells: A histologic, ultrastructural and immunoelectron microscopic study. Acta Neuropathol 101: 631–637.
Horvath E, Kovacs K, 1998 The adenohypophysis. In: Kovacs K, Asa SL (eds): Functional endocrine pathology, ed 2nd Malden, Blackwell; pp, 247–281.
Horvath E, Scheithauer BW, Kovacs K, Lloyd RV, 2002 Hypothalamus and pituitary. In: Graham DI, Lantos PL (eds): Greenfield’s neuropathology, ed 7th New York, NY, Arnold Publishers, vol 1, pp, 983–1051.
Esteller M, Garcia-Foncillas J, Andion E, et al, 2000 Inactivation of the DNA-repair gene MGMT and the clinical response of gliomas to alkylating agents. N Engl J Med 343: 1350–1354.
Hegi ME, Diserens AC, Godard S, et al, 2004 Clinical trial substantiates the predictive value of O-6-methylguanine-DNA methyltransferase promoter methylation in glioblastoma patients treated with temozolomide. Clin Cancer Res 10: 1871–1874.
Hegi ME, Diserens AC, Gorlia T, et al, 2005 MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 352: 997–1003.
Mollemann M, Wolter M, Felsberg J, Collins VP, Reifenberger G 2005 Frequent promoter hypermethylation and low expression of the MGMT gene in oligodendroglial tumors. Int J Cancer 113: 379–385.
Pollack IF, Hamilton RL, Sobol RW, et al, 2006 O6-methylguanine-DNA methyltransferase expression strongly correlates with outcome in childhood malignant gliomas: Results from the ccg-945 cohort. J Clin Oncol 24: 3431–3437.
Kovacs K, Scheithauer BW, Lombardero M, et al, 2008 MGMT immunoexpression predicts responsiveness of pituitary tumors to temozolomide therapy. Acta Neuropathol 115: 261–262.
McCormack AI, McDonald KL, Gill AJ, 2009 Low 06-methylguanine-DNA methyltransferase (MGMT) expression and response to temozolomide in aggressive pituitary tumors. Clin Endocrinol (Oxf) 71: 226–233.
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Syro, L.V., Scheithauer, B.W., Ortiz, L.D. et al. Effect of Temozolomide in a patient with recurring oncocytic gonadotrophic pituitary adenoma. Hormones 8, 303–306 (2009). https://doi.org/10.14310/horm.2002.1247
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DOI: https://doi.org/10.14310/horm.2002.1247