Pituitary metastasis

Case contributed by Frank Gaillard

Presentation

Endocrine disturbance and a left sided ophthalmoplegia.

Patient Data

Age: 65 years
Gender: Female

MRI pituitary

mri

MRI of the pituitary demonstrates a soft tissue mass filling the fossa, extending up along the infundibulum and into the left cavernous sinus. 

Annotated images

mri

The tumor has squeezed through the diaphragma sella (red arrows) with only some widening, as this has occurred over a short time. There also appears to be dural enhancement anteriorly (blue arrow). Bulging into or frank invasion of the left cavernous sinus (green arrow) is more easily appreciated on non-contrast T1 sequences. Contrast opacifies the sinus and results in tumor enhancement.

The patient went on to have transphenoidal surgery. 

Histology

Paraffin sections show fragments of a densely hypercellular tumor. This is composed of pleomorphic cells with round, oval and angulated hyperchromatic nuclei and a small amount of dense eosinophilic cytoplasm. Scattered mitotic figures are noted. Tumor cells are arranged in linear aggregates and small irregularly shaped islands in a fibrous stroms. Infiltration of pituitary acini is also noted. Strong nuclear staining for estrogen receptor is seen in >90% of tumor cells. Patchy strong nuclear staining for progesterone receptor is also noted as well as strong diffuse membrane staining for E-cadherin.  Strong complete membrane staining for HER-2 is seen in >90% of tumor cells. The features are of metastatic undifferentiated carcinoma arising from breast. 

  • Estrogen receptor: positive
  • Progesterone receptor: positive 
  • HER-2: positive

FINAL DIAGNOSIS: Metastatic undifferentiated carcinoma arising from breast.

Case Discussion

This case illustrates the typical appearances of a pituitary metastasis, which unfortunately closely mimic other pituitary tumors. 

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