gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Pituitary melanoma with pulmonary metastasis: case report and review of the literature

Meeting Abstract

  • Lukas Görtz - Klinikum der Universität zu Köln, Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Niklas Von Spreckelsen - Klinikum der Universität zu Köln, Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Gerrit Brinker - Klinikum der Universität zu Köln, Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Boris Krischek - Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Tobias Blau - Universitätsklinikum Köln, Institut für Neuropathologie, Köln, Deutschland
  • Roland Goldbrunner - Klinikum der Universität zu Köln, Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Marco Timmer - Klinikum der Universität zu Köln, Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 107

doi: 10.3205/17dgnc670, urn:nbn:de:0183-17dgnc6703

Published: June 9, 2017

© 2017 Görtz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Although malignant melanoma frequently metastasizes into the brain, pituitary melanoma is rare. We report an uncommon case of pituitary and lung metastatic melanoma and deliver a brief review of the literature on primary and metastatic pituitary melanoma.

Methods: An 81-year old female presented to our emergency room with a 1-week history of progressive horizontal diplopia. She denied further symptoms and any history of cancer. Except of left abducens palsy, neurological examination was normal. Magnetic resonance imaging demonstrated a multinodular pituitary mass with heterogenous contrast enhancement. Considering an endocrine-inactive pituitary adenoma, transsphenoidal resection was performed. Postoperatively, the initial symptoms recovered fully. Histological examination revealed a pituitary malignant melanoma. We performed a literature search on PubMed using the keywords “pituitary”, “metastatic”, “primary” and “melanoma”.

Results: As no history of melanoma was known, staging workup was performed revealing multiple pulmonary lesions. However, there was no evidence of cutaneous, uveal or gastrointestinal melanoma as a primary tumor. Refusing adjuvant brain radiation and further oncological treatment, the patient died 5 months after surgery. Six reports of metastatic and seven reports of primary pituitary melanoma were analyzed. Next to diplopia due to cranial nerves III, IV and VI palsy, diabetes insipidus, headache and visual disturbance were common symptoms at first presentation. In metastatic pituitary melanoma, symptoms tend to progress more rapidly than in primary pituitary melanoma. Due to its melanin content, pituitary melanoma showed a high intensity on T1-weighted images. In contrast, pituitary adenoma is generally T1-hypointense. Transsphenoidal resection often resulted in immediate relief of symptoms. Normally, adjuvant irradiation of the sellar region was performed.

Conclusion: Since pituitary melanoma is rare, it may be misinterpreted as endocrine-inactive adenoma. Occasionally, pituitary melanoma could be identified preoperatively by characteristic appearance of melanin in MRI tomography. Transsphenoidal resection relieves symptoms and prognosis is dependent on overall tumor stage and local tumor control.