Clinical analysis of six cases with metastatic carcinoma in sellar region
LI Xiao-xu1, DENG Kan1, YOU Hui2, ZHANG Yi1, WANG Zhi-cheng1, ZHU Jian-yu1, FENG Ming1, ZHU Hui-juan3, WANG Ren-zhi1, YAO Yong1
1 Department of Neurosurgery, Pituitary Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;
2 Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;
3 Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Objective Metastatic carcinoma in sellar region is a rare disease. This article is to discuss the metastatic origin, clinical manifestations, diagnosis and differential diagnosis of metastatic carcinoma in sellar region, and to summarize the experience in diagnosis and treatment of disease. Methods and Results From January 2014 to October 2019, six patients with metastatic carcinoma in sellar region were confirmed by pathological examinations after endoscopic or microscopic transsphenoidal surgery. Four patients presented with mass effect in sellar region as the first manifestation, and 2 patients were associated with a history of malignant neoplasm. The common clinical manifestations were headache and visual disturbance. The lesions mainly involved cavernous sinus and pituitary gland. Three patients whose lesions involved adenohypophysis presented with pituitary hypofunction, of which 2 patients were diagnosed as non- functional pituitary adenoma on admission. Conclusions Presentations associated with metastatic carcinoma in sellar region can be the first manifestation of malignant neoplasm. Compared with pituitary adenomas, metastatic carcinoma in sellar region is more prone to present with diabetes insipidus and pituitary hypofunction. Relying solely on imaging diagnosis is relatively limited, and differential diagnosis should be considered in multiple aspects to reduce the misdiagnosis rate.
李晓旭, 邓侃, 有慧, 张毅, 王志成, 朱建宇, 冯铭, 朱惠娟, 王任直, 姚勇. 鞍区转移癌六例临床分析[J]. 中国现代神经疾病杂志, 2020, 20(3): 186-190.
LI Xiao-xu, DENG Kan, YOU Hui, ZHANG Yi, WANG Zhi-cheng, ZHU Jian-yu, FENG Ming, ZHU Hui-juan, WANG Ren-zhi, YAO Yong. Clinical analysis of six cases with metastatic carcinoma in sellar region. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(3): 186-190.
Al-Aridi R, El Sibai K, Fu P, Khan M, Selman WR, Arafah BM. Clinical and biochemical characteristic features of metastatic cancer to the sella turcica: an analytical review[J]. Pituitary, 2014, 17:575-587.
Altay T, Krisht KM, Couldwell WT. Sellar and parasellar metastatic tumors[J]. Int J Surg Oncol, 2012:ID647256.
Morita A, Meyer FB, Laws ER Jr. Symptomatic pituitary metastases[J]. J Neurosurg, 1998, 89:69-73.
Ismail E, Issam L, Hamid M. Pituitary metastasis of rhabdomyosarcoma: a case report and review of the literature[J]. J Med Case Rep, 2014, 8:144.
Tanaka T, Hiramatsu K, Nosaka T, Saito Y, Naito T, Takahashi K, Ofuji K, Matsuda H, Ohtani M, Nemoto T, Suto H, Yamamoto T, Kimura H, Nakamoto Y. Pituitary metastasis of hepatocellular carcinoma presenting with panhypopituitarism: a case report[J]. BMC Cancer, 2015, 15:863.
Wang A, Carberry N, Solli E, Kleinman G, Tandon A. Metastatic mantle cell lymphoma to the pituitary gland: case report and literature review[J]. Case Rep Oncol, 2016, 9:25-32.
Liu H, Xiao YD, Peng SP, Zhou SK, Liu J. Pituitary metastasis of choriocarcinoma: a case report[J]. Oncol Lett, 2016, 11: 1517-1520.
Komninos J, Vlassopoulou V, Protopapa D, Korfias S, Kontogeorgos G, Sakas DE, Thalassinos NC. Tumors metastatic to the pituitary gland: case report and literature review[J]. J Clin Endocrinol Metab, 2004, 89:574-580.
Di Nunno V, Mollica V, Corcioni B, Fiorentino M, Nobili E, Schiavina R, Golfieri R, Brunocilla E, Ardizzoni A, Massari F. Clinical management of a pituitary gland metastasis from clear cell renal cell carcinoma[J]. Anticancer Drugs, 2018, 29:710-715.
Hanna FW, Williams OM, Davies JS, Dawson T, Neal J, Scanlon MF. Pituitary apoplexy following metastasis of bronchogenic adenocarcinoma to a prolactinoma[J]. Clin Endocrinol, 1999, 51:377-381.
Abe T, Matsumoto K, Iida M, Hayashi M, Sanno N, Osamura RY. Malignant carcinoid tumor of the anterior mediastinum metastasis to a prolactin-secreting pituitary adenoma: a case report[J]. Surg Neurol, 1997, 48:389-394.
Chandra V, Mcdonald LW, Anderson RJ. Metastatic small cell carcinoma of the lung presenting as pituitary apoplexy and Cushing's syndrome[J]. J Neurooncol, 1984, 2:59-66.
Sanno N, Teramoto A, Osamura RY, Genka S, Katakami H, Jin L, Lloyd RV, Kovacs K. A growth hormone-releasing hormone-producing pancreatic islet cell tumor metastasized to the pituitary is associated with pituitary somatotroph hyperplasia and acromegaly[J]. J Clin Endocrinol Metab, 1997, 82:2731-2737.
Ariel D, Sung H, Coghlan N, Dodd R, Gibbs IC, Katznelson L. Clinical characteristics and pituitary dysfunction in patients with metastatic cancer to the sella[J]. End Prac, 2013, 19:914-919.
He W, Chen F, Dalm B, Kirby PA, Greenlee JD. Metastatic involvement of the pituitary gland: a systematic review with pooled individual patient data analysis[J]. Pituitary, 2015, 18: 159-168.