gms | German Medical Science

Objective: Despite a high prevalence of pituitary adenomas, there are only a few reported cases of pituitary carcinoma in the literature. Most of these were secreting or derived from secreting adenomas. We report here the case of a pituitary carcinoma with metastases developing from a non-functioning macroadenoma.

Method: Case Report

Results: A 39-year-old male suffered from symptomatic chiasmatic compression by an intra- and suprasellar tumor invading the right cavernous sinus. Subtotal transnasal resection was carried out; preoperatively existing pituitary insufficiency was substituted in the usual manner. Histological evaluation revealed a pituitary adenoma WHO grade I. Six months later, the patient developed acute paresis of the right Nn. VI and III. MRI revealed a recurrent tumor in the cavernous sinus, which was treated by LINAC irradiation (13Gy). One year later, dramatic tumor progression with visual impairment and diabetes insipidus occurred. According to the tumor extension staged transcranial and transnasal surgery was necessary. During targeted diagnostic workup osseous and liver metastases were assessed. Biopsy of liver metastasis revealed an epithelial tumor with elevated proliferation index. Morphological and immunohistochemical identity with the pituitary tumor was proven, consequently the diagnosis of a pituitary carcinoma was made. Radiation therapy and systemic chemotherapy were scheduled. Currently the patient is still under therapy.

Conclusions: This case report illustrates the clinical course of a rare pituitary carcinoma with metastases. Up to now, only about 30 similar cases in non-functioning pituitary tumors have been described. Diagnosis in pituitary carcinomas has to be based on the clinical course and not solely on the histopathological findings.