Objective: Pituitary carcinomas are extremely rare tumors associated with poor prognosis despite surgery, radiation, and chemotherapy. The hallmark of diagnosis implies subarachnoid, brain, or systemic tumor spread.Methods: We report a case of rapid transformation of atypical nonfunctioning pituitary adenoma to a carcinoma.Results: A 64-year-old woman presented with sudden onset of ophthalmoplegia. Magnetic resonance imaging (MRI) scan showed a pituitary macroadenoma (2.2 × 2.1 cm) with invasion o. The right cavernous sinus. Biochemical data was consistent with a nonfunctioning pituitary adenoma. Pathology showed a pituitary adenoma with negative immunohistochemistry for pituitary hormones. The patient returned a month later with weakness, lethargy, and a dilated nonreactive right pupil. MRI showed an invasive large mass (5 × 4.7 cm). After an emergent second transsphenoidal surgery, histopathologic examination revealed a widely infiltrative neoplasm invadin. The overlying mucosa and showing a high mitotic activity and necrosis and a very high Ki-67 (MIB-1) proliferation index (80%). MIB-1 retrospectively performed o. The first specimen was also elevated (30%). Soon afte. The second surgery, MRI showed a 7.9 × 8.0 cm mass that metastasized to dura mater and extended int. The right orbit, right middle cranial fossa, nasopharynx, clivus, posterior fossa, and alon. The right tentorium cerebelli, resulting in significant compression o. The brainstem.Conclusion: Development of a pituitary carcinoma from an adenoma is an exceptional occurrence and predictors of such course are currently lacking. A very high Ki-67 proliferation index should raise concern of a pituitary carcinoma in situ or premetastatic carcinoma.
ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism