CONTEXT: Pituitary tumors are rare, and pituitary carcinomas are rarer still. Prognosis is poor, with less than 50% of patients surviving past 1 year after diagnosis. In this case of spinal metastasis from an adrenocorticotropic hormone-secreting pituitary carcinoma, the intradural extramedullary metastases recurred in the same lumbar area 6 years apart. FINDINGS: Fourteen years prior to presentation in our clinic, a 48-year-old woman was diagnosed with pituitary adenoma which was treated with resection followed by radiation. Eight years later, an intradural extramedullary spinal drop metastasis at L2-L3 was again treated with resection and radiation. Three years later, magnetic resonance imaging (MRI) revealed a mass encasing the right carotid artery, which was treated for 1 year with chemotherapy using temozolomide (Temodar). Three years later, MRI showed intradural extramedullary metastases at the L3-L4 intervertebral disc space and behind the L3 vertebral body; treatment was again resection followed by radiation. Back pain and weakness resolved after surgery and her neurological examination returned to baseline. There was no evidence of recurrence 1 year after surgery. CONCLUSION/CLINICAL RELEVANCE: In this unusual case, this pituitary carcinoma metastasized twice in 6 years to virtually the same intradural extramedullary lumbar region. Surgical resection of these masses aided in relieving neurological symptoms and prolonging life.
CONTEXT: Pituitary tumors are rare, and pituitary carcinomas are rarer still. Prognosis is poor, with less than 50% of patients surviving past 1 year after diagnosis. In this case of spinal metastasis from an adrenocorticotropic hormone-secreting pituitary carcinoma, the intradural extramedullary metastases recurred in the same lumbar area 6 years apart. FINDINGS: Fourteen years prior to presentation in our clinic, a 48-year-old woman was diagnosed with pituitary adenoma which was treated with resection followed by radiation. Eight years later, an intradural extramedullary spinal drop metastasis at L2-L3 was again treated with resection and radiation. Three years later, magnetic resonance imaging (MRI) revealed a mass encasing the right carotid artery, which was treated for 1 year with chemotherapy using temozolomide (Temodar). Three years later, MRI showed intradural extramedullary metastases at the L3-L4 intervertebral disc space and behind the L3 vertebral body; treatment was again resection followed by radiation. Back pain and weakness resolved after surgery and her neurological examination returned to baseline. There was no evidence of recurrence 1 year after surgery. CONCLUSION/CLINICAL RELEVANCE: In this unusual case, this pituitary carcinoma metastasized twice in 6 years to virtually the same intradural extramedullary lumbar region. Surgical resection of these masses aided in relieving neurological symptoms and prolonging life.
Authors: Marco Losa; Elena Mazza; Maria Rosa Terreni; Ann McCormack; Anthony J Gill; Micaela Motta; Maria Giulia Cangi; Anna Talarico; Pietro Mortini; Michele Reni Journal: Eur J Endocrinol Date: 2010-09-24 Impact factor: 6.664
Authors: P J Pernicone; B W Scheithauer; T J Sebo; K T Kovacs; E Horvath; W F Young; R V Lloyd; D H Davis; B L Guthrie; W C Schoene Journal: Cancer Date: 1997-02-15 Impact factor: 6.860
Authors: Rita E Landman; Melvin Horwith; Ralph E Peterson; Alexander G Khandji; Sharon L Wardlaw Journal: J Clin Endocrinol Metab Date: 2002-07 Impact factor: 5.958
Authors: Oscar D Bruno; Lea Juárez-Allen; Silvia B Christiansen; Marcos Manavela; Karina Danilowicz; Carlos Vigovich; Reynaldo M Gómez Journal: Int J Endocrinol Date: 2015-05-27 Impact factor: 3.257
Authors: Luis Rafael Moscote-Salazar; Guru Dutta Satyarthee; Willem Guillermo Calderon-Miranda; Jorge Aquino Matus; Alfonso Pacheco-Hernandez; Paulo Cesar Puac-Polanco; Amit Agrawal Journal: J Neurosci Rural Pract Date: 2018 Jan-Mar