Pituitary metastasis

Case contributed by A.Prof Frank Gaillard

Presentation

Decreased vision and right CN III palsy.

Patient Data

Age: 35 years
Gender: Female
MRI

There is a heterogenous predominantly T1 isointense suprasellar mass that encases/narrows the cavernous segment of the right internal carotid artery. The optic chiasm is draped over the mass, with mild compression of the optic chiasm and adjoining right optic nerve. The mass enhances vividly in a heterogeneous fashion on dynamic sequences.

Case Discussion

The patient went on to have a transsphenoidal resection. 

Histology

MICROSCOPIC DESCRIPTION: The sections show features of metastatic poorly differentiated carcinoma. The tumor forms trabeculae and nests. No glandular structures are noted. The tumor cells have enlarged pleomorphic nuclei, prominent nucleoli and small amounts of cytoplasm. No evidence of lymphovascular invasion is seen. There is no normal anterior pituitary tissue included.

  • Estrogen receptor: Negative
  • Progesterone receptor: Negative
  • HER-2: Positive (3+)
  • Previous positive SISH noted

FINAL DIAGNOSIS:
Pituitary metastasis: poorly differentiated adenocarcinoma, consistent with breast primary. 

Discussion

At best, the only good clue that this lesion may be a metastasis rather than a far more common macroadenoma is the lack of pituitary fossa enlargement and slight 'fuzziness' to the masses outline. 

 

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Case information

rID: 33749
Published: 27th Jun 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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