Presentation
Addison's syndrome and hypopituitarism.
Patient Data
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 favored.
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 tumor. Tumor 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 tumor cells, strong staining for GCDFP and cytokeratin CK5&6, weak cytoplasmic staining for E-cadherin and weak (+) nuclear staining for estrogen receptor (ER). No staining for progesterone receptor (PgR) is seen in tumor cells.
FINAL DIAGNOSIS: Metastatic undifferentiated carcinoma arising from breast.
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