Pituitary metastasis

Case contributed by A.Prof Frank Gaillard

Presentation

Hypogonadism.

Patient Data

Age: 55 years
Gender: Female
Modality: MRI

Lobulated enhancing sellar/suprasellar mass has a rounded component occupying the sella (difficult to distinguish from normal pituitary tissue) with thickening enhancement of the pituitary infundibulum is displaced on the left, and a second rounded component of the mass at the superior infundibulum/hypothalamus. 

The posterior aspect of the optic chiasm is contacted by the hypothalamic 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 (please note this study has been targeted to the pituitary, and as such the whole brain has not been imaged) appears unremarkable.

A whole brain axial post contrast sequence demonstrates no further intracranial pathological enhancement.

Conclusion:

The sellar mass extending along infundibulum to hypothalamus is an unusual configuration for a macroadenoma. Given the history of breast carcinoma, metastasis must be the major diagnostic consideration.

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: 26th Jun 2016
Inclusion in quiz mode: Included

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