Pituitary metastasis from breast cancer
The patient was treated in the hospital for multifocal cancer of the lower outer quadrant of the left breast. The patient asked the ophthalmologist about complaints of lacrimation and the loss of sight from the right temple side of vision.
ASNR 2016: This case was submitted as part of the American Society of Neuroradiology (ASNR 2016) Case Of The Day competition, in collaboration with Radiopaedia.org.
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Sella turcica is expanded and depth. Pneumatization of basic sinus is not damaged. Its determined the volume formation in the sellar field, its size 29 x 27 x 21 mm with supra and infrasellum proliferation, as well as the front, with rough and hilly contours. This formation accumulates contrast agent intensively and unevenly. It seems that formation assumes chiasm, which is deformed and increased in volume, heterogeneous. Infundibulum, hiazmo-sellar tank isn’t differentiated. The formation extends to the bottom of the III ventricle. There is swelling and reactive changes along the optic tracts symmetrically of both sides without pathological accumulation of contrast. The formation is adjacent to the both internal carotid arteries.
There are no changes of MR signal in gray and white matter in the basal ganglia, capsula interna corpus callosum. The are no focal changes of MR signal in brainstem and cerebellum. Median brain structures are not displaced.
Brain ventricles are not expanded, their shape is not changed. Lateral ventricles are symmetrical.
The subarachnoid space of the cerebral hemispheres and the cerebellum are not extended. Additional formations in the cerebellopontine angle are not identified. Inner ear canals are not expanded. Craniovertebral transition is without features.Paranasal sinuses and mastoid cells of temporal bones are developed properly, their pneumatization is not damaged. Orbits and retrobulbar space are normal, optic nerves are symmetrical, without features.
CONCLUSION: Volumetric formation of sellar region should be differentiated between macroadenoma and chiasm glioma with the spread on optic tracts.
The case demonstrates an uncommon example of intracranial metastasis from breast cancer in hypophysis, which should be differentiated from other solid and enhancing pituitary region masses such as macroadenoma. The patient was operated. Biopsy revealed metastasis of mammary cancer in hypophysis.