NIMG-89. DISSEMINATED SPINAL METASTASES FROM A PITUITARY CARCINOMA

Abstract

Abstract Pituitary carcinomas are rare malignant neoplasms and rarely result in a solitary spinal metastasis. In this report we describe a case of pituitary carcinoma that metastasized to the spinal canal and the nerve roots at numerous spinal levels, mimicking neurofibromatosis of the spine. This patient is a 72 year old right-handed female with past medical history of pituitary adenoma which was resected 5 years prior and stable on imaging. At presentation, patient was seen for right sciatica, and an MRI showed multiple enhancing intradural extramedullary lesions mainly in the lumbar spine, felt to represent nerve sheath tumors, neurofibromas. She underwent genetic testing, but NF1, NF2, SMARC1B, SPRED1, LTRZ1 were not found to have a mutation. Over a 3 year period, she had progression of her spinal tumors. The pituitary lesion remained stable in appearance. She underwent resection of multiple lumbar lesions and pathology was consistent with pituitary carcinoma.Patient tolerated up to almost 11 full cycles of temozolomide before it was put on hold due to significant deconditioning and lethargy. Imaging revealed a partial response of the spinal cord metastases. This is an unusual presentation for metastatic pituitary carcinoma and delay in diagnosis resulted in significant morbidity.