A pituitary metastasis from occult neuroendocrine carcinoma

Luigi Demarchis; Sabrina Chiloiro; Mattogno Pier Paolo; Antonella Giampietro; Maratta Maria Grazia; Liverana Lauretti; Giovanni Schinzari; Rosalinda Calandrelli; Simona Gaudino; Guido Rindi; Alessandro Olivi; Giampaolo Tortora; Francesco Doglietto; Marinis Laura De; Alfredo Pontecorvi; Antonio Bianchi; Marco Gessi

doi:10.1530/endoabs.99.EP696

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Endocrine Abstracts (2024) 99 EP696 | DOI: 10.1530/endoabs.99.EP696

ECE2024 Eposter Presentations Pituitary and Neuroendocrinology (214 abstracts)

A pituitary metastasis from occult neuroendocrine carcinoma

Luigi Demarchis ¹ , Sabrina Chiloiro ² , Pier Paolo Mattogno ³ , Antonella Giampietro ² , Maria Grazia Maratta ⁴ , Liverana Lauretti ³ , Giovanni Schinzari ⁴ , Rosalinda Calandrelli ⁵ , Simona Gaudino ⁵ , Guido Rindi ⁶ , Alessandro Olivi ³ , Giampaolo Tortora ⁴ , Francesco Doglietto ³ , Laura De Marinis ² , Alfredo Pontecorvi ² , Antonio Bianchi ² & Marco Gessi ⁶

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¹Fondazione Policlinico Universitario A. Gemelli IRCCS, Pituitary United;²Fondazione Policlinico Universitario A. Gemelli IRCCS, Pituitary United;³Fondazione Policlinico Universitario A. Gemelli IRCCS, Neurosurgery;⁴Fondazione Policlinico Universitario A. Gemelli IRCCS, Medical Oncology;⁵Fondazione Policlinico Universitario A. Gemelli IRCCS, Radiology;⁶Fondazione Policlinico Universitario A. Gemelli IRCCS, Anatomic Pathology Section

Background: Pituitary metastases are rare findings and account for 1% of surgically treated pituitary lesions. Despite the low incidence, given the frequent compression exerted on surrounding structures, pituitary metastases can present with major symptoms such as headache, visual disturbances and visual field. Ultimately, damage to the pituitary gland may be associated with electrolyte disturbances.

Clinical case: A 57-year-old male patient was admitted to our hospital for ptosis, lacrimation and diplopia, previously treated with corticosteroids without benefit. A brain contrasted MRI examination showed a sellar lesion, in contact with the optic chiasma, infiltrating the right cavernous sinus, the clivus and the clinoid. Biochemical and hormone examinations showed slight hyperprolactinemia (47 ng/ml) in absence of electrolyte disturbances and deficits of pituitary hormones. The visual field examination detected a left superior-temporal campimetric deficit. Pre-surgery chest X-ray was negative. A sub-total transsphenoidal excision of the lesion was conducted and histologic examination identified a ‘neoplasm with well-differentiated neuroendocrine morphology, relatively monomorphic round cells, intense expression of synaptophysin, chromogranin, 2A-somatostatin receptor, insulinoma-associated protein-1 (INSM1), thyroid transcription factor-1 (TTF1). Neoplastic cells were Pit1-, Tpit-, GATA3-, SF1-, CDX2-, ISLET1-, CAM5.2- and AE1/AE- negative. Proliferative index (MIB1) was 5-7%. Comment: localization of a neuroendocrine tumor (NET). Immunohistochemical pattern suggests a pulmonary origin (possible atypical carcinoid, NET G2)’. The patient underwent a 68-Gallium-DOTA-TOC Positron Emission Tomography/computed tomography (PET-CT) showed the residual sellar tumor with increased SSTR expression. A contrasted total body CT confirmed the residual neoplasia of maximum diameter of 24 millimeters in the right lateral and posterior sellar region, eroding the lamina quadrilateralis and the ipsilateral posterior clinoid process, extending extra compartmentally into the cavernous sinus, encompassing the intracranial portion at the internal carotid artery. Finally, the patient underwent 18-F-fluorodeoxyglucos PET-CT, which detected a more functionally active area in the right parasellar region. All radiological investigations did not reveal the primary tumour and other metastasis. Therefore, according to NET grading, non-detection of primary tumor and persistence of local disease, it is decided to treat the patient with somatostatin receptor ligand and to re-evaluate the status of disease, also considering the possibility of radiotherapy on the residual tumor.

Conclusions: Our case is intended to emphasize the importance of considering the pituitary not only as a site of primary tumor but also as a possible site of metastasis, mainly from breast, lung, and colon cancers, without excluding firstly possible rarer primaries as occult or other side of NETs.