GH Pituitary Carcinoma with Delayed Craniocervical Metastasis: a rare description and pertinent review

Carcinoma Hipofisário de GH com Metástase Craniocervical Tardia: uma descrição rara e revisão pertinente

• Eduardo de Arnaldo Silva Vellutini (1)
• Aldo Eden Cassol Stamm (2)
• Marcos de Queiroz Teles Gomes (3)
• Leonardo Gilmone Ruschel (3)
• Matheus Fernandes de Oliveira (4)
• Luiz Roberto Salgado (5)

• https://doi.org/doi.org/10.22290/jbnc.2023.340111
• J Bras Neurocirur 34(1): 130-136, 2023

Resumo

Introdução: os carcinomas hipofisários (CH) são tumores raros caracterizados pela presença de metástases sistêmicas ou no sistema nervoso central de um adenoma hipofisário prévio. A incidência estimada é inferior a 0,5% dos tumores hipofisários sintomáticos. Os tipos mais comuns são os tumores de corticotrofina e prolactina, seguidos pelos carcinomas de GH e gonadotrofinas. A literatura apresenta cerca de 170 casos de CH, dos quais apenas 11 casos eram tumores secretores de GH. Relato do Caso: relatamos o caso de um paciente do sexo masculino de 63 anos com história de adenoma hipofisário recorrente secretor de GH com uma nova lesão no forame magno. Paciente havia sido submetido previamente a três cirurgias transesfenoidais devido a recidivas locais do tumor. O período de latência entre o diagnóstico do tumor hipofisário e a identificação da metástase foi de 22 anos. As características histológicas da lesão do forame magno foram semelhantes às do tumor selar inicial e imunorreativas para GH. Discussão e conclusão: devemos estar atentos aos riscos de recorrência dos tumores hipofisários, por vezes comportando-se como tumores malignos e apresentando padrões atípicos, mesmo muitos anos após a apresentação inicial. O tratamento deve ser adaptado individualmente para cada paciente com cirurgia, radioterapia e quimioterapia.

Palavras-chave

Carcinoma hipofisário; Adenoma hipofisário; Metástase

Abstract

Introduction: pituitary carcinomas (PC) are rare tumors characterized by the presence of central nervous system or systemic metastases of a previous pituitary adenoma. Estimated incidence is less than 0.5% of symptomatic pituitary tumors. Most common types are corticotrophin and prolactin tumors, followed by GH and gonadotrophin carcinomas. English literature presents about 170 cases of PC, of which only 11 cases were GH secreting tumors. Case Presentation: we report a case of a 63-year-old male patient with history of recurrent GH secreting pituitary adenoma with a new lesion in foramen magnum. Patient had been previously submitted to three transsphenoidal surgeries due to local recurrences of tumor. Latency period between diagnosis of pituitary tumor and identification of metastasis was 22 years. Histological characteristics of foramen magnum lesion were similar to those of initial sellar tumor and immunoreactive for GH. Discussion and Conclusion: we should be aware of recurrence risks of pituitary tumors, behaving sometimes like malignant tumors and presenting atypical patterns, even many years after initial presentation. Treatment should be tailored to individual patient with surgery, radiotherapy and medical therapy.

Keywords

Pituitary carcinoma; Pituitary adenoma; Metastasis

References

1. Stapleton CJ, Liu CY, Weiss MH. The role of sterotactic radiosurgery in the multimodal management of growth hormone-secreting pituitary adenomas. Neurosurg Focus. 2010;29(4):E11. http://dx.doi. org/10.3171/2010.7.FOCUS10159. PMid:20887121.

2. Stewart PM, Carey MP, Graham CT, Wright AD, London DR. Growth hormone secreting pituitary carcinoma: a case report and literature review. Clin Endocrinol. 1992;37(2):189-94. http://dx.doi. org/10.1111/j.1365-2265.1992.tb02306.x. PMid:1395070.

3. Thapar K, Kovacs K, Scheithauer BW, et al. Proliferative activity and invasive-ness among pituitaryadenomas and carcinomas: an analysis using the MIB-1 antibody. Neurosurgery. 1996;38(1):99-106. http:// dx.doi.org/10.1097/00006123-199601000-00024. PMid:8747957.

4. Thapar K, Scheithauer BW, Kovacs K, Pernicone PJ, Laws ER Jr. p53 expression in pituitary adenomas and carcinomas: correlation with invasiveness and tumor growth fractions. Neurosurgery. 1996;38(4):765-70. http://dx.doi.org/10.1227/00006123-199604000- 00027. PMid:8692397.

5. Wang YQ, Fan T, Zhao XG, Liang C, Qi XL, Li JY. Pituitary carcinoma with intraspinal metastasis: report of two cases and review of literature. Int J Clin Exp Pathol. 2015;8(8):9712-7. PMid:26464743.

6. Yamashita S, Izumi M, Nagataki S. Acromegaly and pituitary carcinoma. Ann Intern Med. 1992;117(12):1057-8. http://dx.doi. org/10.7326/0003-4819-117-12-1057. PMid:1443978.

7. Yang I, Kim W, Salles A, Bergsneider M. A systematic analysis of disease control in acromegaly treated with radiosurgery. Neurosurg Focus. 2010;29(4):E13. http://dx.doi.org/10.3171/2010.7.FOCUS10170. PMid:20887123.

8. Bengtsson D, Schroder HD, Andersen M, et al. Long-term outcome and MGMT as a predictive marker in 24 patients with atypical pituitary adenomas and pituitary carcino- mas given treatment with temozolamide. J Clin Endocrinol Metab. 2015;100(4):1689-98. PMid:25646794.

9. Bolfi F, Neves AF, Boguszewski CL, Nunes-Nogueira VS. Mortality in acromegaly decreased in the last decade: a systematic review and meta-analysis. Eur J Endocrinol. 2018;179(1):59-71. PMid:29764907.

10. Campderá M, Palacios N, Aller J, et al. Temozolomide for aggressive ACTH pituitary tumors: failure of a second course of treatment. Pituitary. 2016;19(2):158-66. PMid:26586560.

11. Carrasco CA, Gadelha M, Manavela M, Bruno OD. Aggressive tumors and difficult choices in acromegaly. Pituitary. 2014;17(Suppl 1):S24-9. PMid:24293348.

12. Colao A, Bronstein MD, Freda P, et al. Pasireotide versus octreotide in acromegaly: a head-to-head superiority study. J Clin Endocrinol Metab. 2014;99(3):791-9. PMid:24423324.

13. Dayan C, Guilding T, Hearing S, et al. Biochemical cure of recurrent acromegaly by resection of cervical spinal canal metastasis. Clin Endocrinol. 1996;44(5):597-602. PMid:8762737.

14. Giustina A, Arnaldi G, Bogazzi F, et al. Pegvisomant in acromegaly: an update. J Endocrinol Invest. 2017;40(6):577-89. PMid:28176221.

15. Greenman Y, Woolf P, Coniglio J, et al. Remission of acromegaly caused by pituitary car- cinoma after surgical excision of growth hormone-secreting metastasis detected by 111-Indium pentetreotide scan. J Clin Endocrinol Metab. 1996;81(4):1628-33. PMid:8636379.

16. Hagen C, Schroeder HD, Hansen S, Hagen C, Andersen M. Temozolomide treatment of a pituitary carcinoma and two pitui- tary macroadenomas resistant to conventional therapy. Eur J Endocrinol. 2009;161(4):631-7. PMid:19654234.

17. Ilkhchoui Y, Appelbaum DE, Pu Y. FDG-PET/CT findings of a metastatic pituitary tumor. Cancer Imaging. 2010;10(1):114-6. PMid:20299302.

18. Jallad RS, Musolino NR, Salgado LR, Bronstein MD. Treatment of acromegaly: is there still a place for radiotherapy? Pituitary. 2007;10(1):53- 9. PMid:17318438.

19. Kaltsas GA, Nomikos P, Kontogeorgos G, Buchfelder M, Grossman AB. Clinical review: diagnosis and management of pituitary carcinomas. J Clin Endocrinol Metab. 2005;90(5):3089-99. PMid:15741248.

20. Lall RR, Shafizadeh SF, Lee KH, et al. Orbital metastasis of pituitary growth hormone secreting carcinoma causing lateral gaze palsy. Surg Neurol Int. 2013;4:59. PMid:23646269.

21. Landman RE, Horwith M, Peterson RE, Khandji AG, Wardlaw SL. Long-term survival with ACTH-secreting carcinoma of the pituitary: a case report and review of the literature. J Clin Endocrinol Metab. 2002;87(7):3084-9. PMid:12107205.

22. Lasolle H, Cortet C, Castinetti F, et al. Temozolomide treatment can improve overall survival in aggressive pituitary tumors and pituitary carcinomas. Eur J Endocrinol. 2017;176(6):769-77. PMid:28432119.

23. Lavrentaki A, Paluzzi A, Wass JAH, Karavitaki N. Epidemiology of acromegaly: review of population studies. Pituitary. 2017;20(1):4-9. PMid:27743174.

24. Roux CW, Mulla A, Meeran K. Pituitary carcinoma as a cause of acromegaly. N Engl J Med. 2001;345(22):1645-6. PMid:11757521.

25. Lehman NL, Horoupian DS, Harsh GR IV. Synchronous subarachnoid drop metastases from a pituitary adenoma with multiple recurrences. J Neurosurg. 2003;98(5):1120-3. PMid:12744376.

---

1 MD, PhD, Neurosurgeon, DFV Neuro, Sírio Libanês Hospital, Oswaldo Cruz German Hospital; ENT Partner DFV Neuro, São Paulo, Brazil.

2 MD, PhD, Otorhinolaryngologist, Sírio Libanês Hospital, Oswaldo Cruz German Hospital; ENT Partner DFV Neuro, Centro de Otorrino de São Paulo, São Paulo, Brazil.

3 MD, Neurosurgeon, DFV Neuro, Sírio Libanês Hospital, Oswaldo Cruz German Hospital - São Paulo-Brazil; ENT Partner DFV Neuro, São Paulo, Brazil.

4 MD, PhD, Neurosurgeon, DFV Neuro, Sírio Libanês Hospital, Oswaldo Cruz German Hospital; ENT Partner DFV Neuro, São Paulo, Brazil.

5 MD, PhD, General Internal Medicine Service, Clinics Hospital, São Paulo, Brazil.

 

Received Nov 16, 2021

Corrected Jan 9, 2023

Accepted Jan 23, 2023