Pituitary carcinomas are rare tumours indistinguishable from pituitary adenomas on imaging and defined only by the presence of central nervous system or systemic metastases.
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Epidemiology
The incidence is estimated at less than 0.5% of the pituitary symptomatic tumours 1.
Clinical presentation
They are usually diagnosed as invasive macroadenomas and for such have the similar clinical presentation.
Pathology
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.
Radiographic features
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.
Nuclear medicine
Positron emission tomography scan using 18F-labelled 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.
Differential diagnosis
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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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