A type of pituitary carcinoma
Asai et al reported a rare case of GH secreting pituitary neuroendocrine tumor with hematogenous metastasis to the dura mater of the cerebral convexity.
Immunohistological staining was essential to the diagnosis. The histological findings demonstrated that the metastasis was blood-borne. Extensive removal of the tumor and postoperative chemotherapy resulted in partial remission 1).
Mountcastle et al reported a case of a 56-year-old acromegalic man with cervical lymphatic and spinal metastases from a primary pituitary carcinoma. Elevated basal levels of plasma growth hormone (GH) and insulin growth factor-1/Somatomedin C (IGF-1/SmC) were found. GH levels did not increase after TRH or LHRH administration but decreased after L-Dopa and glucose. Immunostaining of the metastatic tumor for GH and electron microscopy findings confirmed the diagnosis of pituitary GH-secreting carcinoma. Striking clinical improvement and a 46% decrease in plasma GH levels were observed with bromocriptine treatment, although IGF-1/SmC levels increased during therapy. The clinical course of most reported cases of pituitary adenocarcinoma has been one of progressive intracranial expansion of a pituitary neoplasm. In only 25% were metastatic lesions discovered antemortem, and disabling symptomatology caused by metastases was rare. Only four previously reported patients of 36 with pituitary carcinoma had acromegaly 2).
Tanaka T, Kato N, Aoki K, Watanabe M, Arai T, Hasegawa Y, Abe T. Long-term follow-up of growth hormone-producing pituitary carcinoma with multiple spinal metastases following multiple surgeries: case report. Neurol Med Chir (Tokyo). 2013;53(10):707-11. Epub 2013 Sep 27. PubMed PMID: 24077272.