Pituitary carcinoma with endolymphatic sac metastasis

Irida Balili, Steven Sullivan, Paul Mckeever, Ariel Barkan

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Pituitary carcinoma is characterized by the presence of a metastatic lesion(s) in a location non-contiguous with the original pituitary tumor. The mechanism(s) of malignant transformation are not known. A 15 year-old male was diagnosed in 1982 with a pituitary macroadenoma and acromegaly (random GH 67 ng/ml and no suppression by oral glucose). His prolactin was normal between 18 and 23 ng/ml. Transcranial resection in July 1983 was followed by radiation therapy. The tumor was immunopositive for GH and prolactin. The proliferation MIB-1 index was 0-1%. With aqueous Octreotide 100 mcg 49 daily both GH and IGF-1 became normal. The patient was lost to follow-up and was treated by his local physician. In 2001, his IGF-1 level was 1271 ng/ml, and his random GH was 1.8-2.4 ng/ml by ILMA despite progressive increase in the dose of Sandostatin LAR to 140 mg/month in divided doses. Prolactin remained normal or minimally increased between 15 and 25 ng/ml. In 2009 he was diagnosed with the tumor in the location of left endolymphatic sac. Histological examination showed low grade pituitary carcinoma strongly immunopositive for prolactin but negative for GH. MIB-1 antibody labeled 0-5% cells. In 2012 endoscopic resection of the pituitary tumor remnant was attempted. Immunohistochemical stains were strongly immunopositive for both prolactin and GH, similar to his original pituitary tumor. The MIB-1 proliferation index was low from 0 to 1%. To our knowledge this is the first case of pituitary carcinoma in the endolymphatic sac region. The dichotomy between the cell population of the pituitary lesion (GH/prolactin producing) and the metastasis (purely prolactin-producing) may suggest that the metastatic pituitary lesion derived from a clone distinct from the original one.

Original languageEnglish (US)
Pages (from-to)210-213
Number of pages4
JournalPituitary
Volume17
Issue number3
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Endolymphatic Sac
Pituitary Neoplasms
Prolactin
Neoplasm Metastasis
Octreotide
Insulin-Like Growth Factor I
Acromegaly
Lost to Follow-Up
Neoplasms
Coloring Agents
Radiotherapy
Clone Cells
Physicians
Glucose

Keywords

  • Carcinoma
  • GH
  • Pituitary
  • Prolactin

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Pituitary carcinoma with endolymphatic sac metastasis. / Balili, Irida; Sullivan, Steven; Mckeever, Paul; Barkan, Ariel.

In: Pituitary, Vol. 17, No. 3, 2014, p. 210-213.

Research output: Contribution to journalArticle

Balili, I, Sullivan, S, Mckeever, P & Barkan, A 2014, 'Pituitary carcinoma with endolymphatic sac metastasis', Pituitary, vol. 17, no. 3, pp. 210-213. https://doi.org/10.1007/s11102-013-0489-x
Balili, Irida ; Sullivan, Steven ; Mckeever, Paul ; Barkan, Ariel. / Pituitary carcinoma with endolymphatic sac metastasis. In: Pituitary. 2014 ; Vol. 17, No. 3. pp. 210-213.
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AB - Pituitary carcinoma is characterized by the presence of a metastatic lesion(s) in a location non-contiguous with the original pituitary tumor. The mechanism(s) of malignant transformation are not known. A 15 year-old male was diagnosed in 1982 with a pituitary macroadenoma and acromegaly (random GH 67 ng/ml and no suppression by oral glucose). His prolactin was normal between 18 and 23 ng/ml. Transcranial resection in July 1983 was followed by radiation therapy. The tumor was immunopositive for GH and prolactin. The proliferation MIB-1 index was 0-1%. With aqueous Octreotide 100 mcg 49 daily both GH and IGF-1 became normal. The patient was lost to follow-up and was treated by his local physician. In 2001, his IGF-1 level was 1271 ng/ml, and his random GH was 1.8-2.4 ng/ml by ILMA despite progressive increase in the dose of Sandostatin LAR to 140 mg/month in divided doses. Prolactin remained normal or minimally increased between 15 and 25 ng/ml. In 2009 he was diagnosed with the tumor in the location of left endolymphatic sac. Histological examination showed low grade pituitary carcinoma strongly immunopositive for prolactin but negative for GH. MIB-1 antibody labeled 0-5% cells. In 2012 endoscopic resection of the pituitary tumor remnant was attempted. Immunohistochemical stains were strongly immunopositive for both prolactin and GH, similar to his original pituitary tumor. The MIB-1 proliferation index was low from 0 to 1%. To our knowledge this is the first case of pituitary carcinoma in the endolymphatic sac region. The dichotomy between the cell population of the pituitary lesion (GH/prolactin producing) and the metastasis (purely prolactin-producing) may suggest that the metastatic pituitary lesion derived from a clone distinct from the original one.

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