Pituitary carcinomas are rare but represent a particular challenge to clinical practice. We report a case of pituitary carcinoma with metastatic disease in a separate non-contiguous foci within the central nervous system. A 64 year old man presented with a large non-functioning pituitary adenoma manifesting as headache, third pair of cranial nerves paralysis, panhypopituitarism and impaired visual acuity in 1996.The tumour was grossly removed through a right pterional craniotomy. Conventional radiotherapy for the residual tumour was performed in 1997. Follow-up magnetic resonance (MR) imaging revealed a residual tumour close to the left cavernous sinus and in the posterior sellar region. New signs of mass effect with headache, ataxia and dismetria developed in 2006. A MR showed a tumour located in the cerebellar vermis, which was excised by suboccipital craniotomy. Histological examination of the specimen revealed typical pituitary adenoma. The post-surgical MR revealed only a residual tumour in the sellar region. Other studies including chest radiography, abdominal ultrasound, vertebral column MR, octreoscan and positron emission tomography (PET) did not show any other metastases. Conclusions: this case documents an 11 year history of a rare non-functioning pituitary carcinoma which metastasized in cerebellum and shows that pituitary carcinomas may present as typical pituitary adenomas which may reveal their malignant character with distant metastases only as time progresses. Distant lesions should be removed for histological evaluation to plan the subsequent management.
03 - 07 May 2008
European Society of Endocrinology