Pituitary carcinoma

Last revised by Henry Knipe on 30 Sep 2022

Pituitary carcinomas are rare tumors indistinguishable from pituitary adenomas on imaging and defined only by the presence of central nervous system or systemic metastases.

The incidence is estimated at less than 0.5% of the pituitary symptomatic tumors 1

They are usually diagnosed as invasive macroadenomas and for such have the similar clinical presentation. 

Pituitary carcinomas are composed of adenohypophysial cells and do not show obvious microscopic features of malignancy. The majority are hormonally active 1,2.

Metastases may occur through the adjacent lymphatic and vascular spaces, hematogeneously, or from invasion into the subarachnoid space. 

They are indistinguishable from pituitary macroadenomas on imaging, and local invasion to the cavernous sinus and adjacent structures are features of both tumors. The diagnosis may be inferred when metastases are identified. 

Positron emission tomography scan using 18F-labeled deoxyglucose have been used for staging and follow-up of the metastatic lesions.

These tumors have a poor prognosis with a reported mean survival time between 1 to 2 years 2.

  • metastasis to the pituitary gland
    • as pituitary carcinomas are a rare entity, it is more reasonable to consider other primary sites in patients presenting with a pituitary lesion and concomitant peripheral metastases

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