Pituitary carcinomas are rare tumours 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 tumours 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 tumours. 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.
Treatment and prognosis
These tumours 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
- 1. Kaltsas GA, Nomikos P, Kontogeorgos G et-al. Clinical review: Diagnosis and management of pituitary carcinomas. J. Clin. Endocrinol. Metab. 2005;90 (5): 3089-99. doi:10.1210/jc.2004-2231 - Pubmed citation
- 2. Guzel A, Tatli M, Senturk S et-al. Pituitary carcinoma presenting with multiple metastases: case report. J. Child Neurol. 2008;23 (12): 1467-71. doi:10.1177/0883073808319078 - Pubmed citation
Pituitary region masses
- pituitary gland anatomy
- pituitary MRI - an approach
pituitary region masses
- most common pituitary region masses
- solid and enhancing pituitary region mass
- mixed cystic and solid pituitary region mass
- mostly/purely cystic pituitary region masses
- purely intrasellar pituitary mass
- pituitary region mass with intrinsic high T1 signal
- abnormal enhancement/bulkiness of the pituitary infundibulum
- enlarged sella turcica
- mnemonic: SATCHMO
- history of imaging the pituitary region
- pituitary adenoma (commonest in the adult population)
- pituitary carcinoma
- pituitary lymphoma
- optic pathway glioma
- dermoid (CNS) / epidermoid / intracranial teratoma
- spindle cell oncocytomas
- pituitary metastases
- granular cell tumour of the pituitary (pituitary choristoma)
- pilocytic astrocytoma of the neurohypophysis (infundibuloma)
- cellular infiltrates
- other lesions
- pituitary tumours