Pituitary metastasis

Case contributed by A.Prof Frank Gaillard

Presentation

Addison's syndrome and hypopituitarism.

Patient Data

Age: 60 years
Gender: Female
Modality: MRI

A muli-lobulated enhancing sellar/suprasellar mass involving the pituitary gland and infundibulum is present. The posterior aspect of the optic chiasm is contacted by the superior component of the mass without compression. No evidence of cavernous sinus invasion. The flow voids of both cavernous internal carotid arteries are preserved. 

The remainder of the imaged brain appears unremarkable.

Conclusion:

The sellar mass extending along infundibulum to hypothalamus is an unusual configuration for a macroadenoma. Given the history of breast carcinoma, pituitary metastasis is favoured. 

Lymphocytic hypophysitis, histiocytosis and granulomatous hypophysitis are less likely possibilities given the clinical context.

Case Discussion

The patient went on to have surgery. 

Histology

MICROSCOPIC DESCRIPTION:

Paraffin sections show small fragments of a densely hypercellular tumour. Tumour cells have pleomorphic round and oval vesicular nuclei with conspicuous nucleoli and a variable amount of pale cytoplasm. These are arranged in solid aggregates within a vascular stroma. Frequent mitotic figures are identified. Immunohistochemistry shows strong (+++) membrane staining for HER-2 in >90% of tumour cells, strong staining for GCDFP and cytokeratin CK5&6, weak cytoplasmic staining for E-cadherin and and weak (+) nuclear staining for oestrogen receptor (ER). No staining for progesterone receptor (PgR) is seen in tumour cells.

FINAL DIAGNOSIS: Metastatic undifferentiated carcinoma arising from breast.

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Case Information

rID: 44692
Case created: 2nd May 2016
Last edited: 6th May 2017
Inclusion in quiz mode: Included

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