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Pituitary metastasis

Case contributed by: Dr Frank Gaillard

Presentation:

Endocrine disturbance and a left sided ophthalmoplegia.

Patient Data:

Age: 65 years
Gender: Female
Race: Caucasian
From the case: Pituitary metastasis

MRI pituitary

Modality: MRI

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T1 C+

MRI of the pituitary demonstrates a soft tissue mass filling the fossa, extending up along the infundibulum and into the left cavernous sinus. 

From the case: Pituitary metastasis

Annotated images

Modality: Annotated image

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  • The tumour has squeezed through the diaphragma sella (red arrows) with only some widening, as this has occurred over a short time. There also appears to be dural enhancement anteriorly (blue arrow).
The tumour has squeezed through the diaphragma sella (red arrows) with only some widening, as this has occurred over a short time. There also appears to be dural enhancement anteriorly (blue arrow).

The patient went on to have transphenoidal surgery. 

Histology

Paraffin sections show fragments of a densely hypercellular tumour. This is composed of pleomorphic cells with round, oval and angulated hyperchromatic nuclei and a small amount of dense eosinophilic cytoplasm. Scattered mitotic figures are noted. Tumour cells are arranged in linear aggregates and small irregularly shaped islands in a fibrous stroms. Infiltration of pituitary acini is also noted. Strong nuclear staining for oestrogen receptor is seen in >90% of tumour cells. Patchy strong nuclear staining for progesterone receptor is also noted as well as strong diffuse membrane staining for E-cadherin.  Strong complete membrane staining for HER-2 is seen in >90% of tumour cells. The features are of metastatic undifferentiated carcinoma arising from breast. 

  • Oestrogen receptor: positive
  • Progesterone receptor: positive 
  • HER-2: positive

FINAL DIAGNOSIS: Metastatic undifferentiated carcinoma arising from breast.

Case Discussion:

This case illustrates the typical appearances of a pituitary metastasis, which unfortunately closely mimic other pituitary tumours. 

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