Pituitary metastasis

Case contributed by A.Prof Frank Gaillard

Presentation

Endocrine disturbance and a left sided ophthalmoplegia.

Patient Data

Age: 65 years
Gender: Female

MRI pituitary

Modality: MRI

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

Annotated images

Modality: MRI

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). Bulging into or frank invasion of the left cavernous sinus (green arrow) is more easily appreciated on non-contrast T1 sequences. Contrast opacifies the sinus and results in tumour enhancement.

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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Case Information

rID: 7252
Case created: 23rd Sep 2009
Last edited: 6th Jan 2016
Inclusion in quiz mode: Included

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