Abstract
Pituitary carcinomas are defined as pituitary tumors with craniospinal and/or systemic metastasis. These are rare and highly aggressive lesions. We present an unusual case of a 52-year-old male who had a pituitary adenoma removed via craniotomy. The tumor recurred three years post-op near the surgical tract, and slowly enlarged before removal two years later. Technically, this lesion was defined as a pituitary carcinoma, even though the histology and clinical course were atypical. There is no standardized grading system for pituitary tumors and ideal criteria should correlate clinically. Treatment for pituitary carcinoma is multimodal and largely empiric. We believe this case illustrates that current definitions of pituitary carcinoma are incomplete.
Highlights
Pituitary carcinomas are defined as pituitary tumors with craniospinal and/or systemic metastasis
We present an unusual case of a 52year-old male who had a pituitary adenoma removed via craniotomy
We present a rare case of either seeding of a pituitary adenoma or an atypical pituitary carcinoma
Summary
Pituitary carcinomas are defined as pituitary tumors with craniospinal and/or systemic metastasis [1]. We present a rare case of either seeding of a pituitary adenoma or an atypical pituitary carcinoma. This illustrates the need for improved clinical definitions to guide treatment. Axial (A, B), Coronal (C), and Sagittal (D, E, and F) images showed an enhancing, lobulated mass in the sella arising from the pituitary enveloping the right carotid siphon, right cavernous sinus, optic chiasm, and right optic nerve. A contrast-enhanced brain MRI showed new enhancing extra-axial masses along the right anterior interhemispheric falx measuring 14 × 7 mm and 9 × 7 mm. The new extra-axial lesions were initially concerning for cerebral abscesses, and were treated with long-term intravenous antibiotics He improved and remained asymptomatic for the two years. Further recurrence would prompt additional consideration for radiation and or chemotherapy
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