Introduction: Pituitary metastases are rare complications of malignancy, representing only 1% of surgical tumours of the pituitary gland. They are usually encountered in elderly patients with disseminated malignant disease. The most frequent are metastases of breast and lung cancer. In this report, we describe a rare case of a metastatic breast cancer to the pituitary gland.
Observation: A 32-year-old female presented with blurred vision and diminished visual acuity in the last two weeks. Her past personal history included invasive ductal breast carcinoma diagnosed 2 years ago, treated with left mastectomy, axillary dissection and adjuvant chemotherapy. In the previous year, multiple bone metastases were diagnosed and she was treated with palliative radiotherapy. The ophthalmic exam displayed a papill edema in both eyes and a bi-temporal hemianopsia. Magnetic resonance imaging of the pituitary region showed a large heterogeneous mass measuring 27 x 22 x 19 mm. Moreover, the mass had a supra-sellar extension and was infiltrating the optic chiasm. Laboratory investigation showed panhypopituitarism. The patient was put on hormone replacement therapy. Then, a transsphenoidal surgery was performed with a subtotal resection of the tumour. The histological findings identified the mass as a malignant neoplasm compatible with metastatic breast cancer and specifically a poorly differentiated adenocarcinoma.
Conclusion: Pituitary metastases are uncommon and difficult to diagnose. Clinical neurological symptoms and signs of panhypopituitarism should suggest the presence of a pituitary metastasis in a cancer patient, particularly in a context of metastatic disease. Diagnosis needs to be confirmed by radiological imaging and histology. Treatment is essentially palliative and depends on the extent of disease and symptoms.
19 May 2018 - 22 May 2018