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Table of Contents    
LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 1  |  Page : 70-71

Isolated metastasis of breast cancer to the pituitary gland


1 Department of Orthopedic Surgery, Spine Center, University of California, San Francisco, CA, USA
2 Department of Neurosurgery, Marmara University, Istanbul, Turkey
3 Department of Neurosurgery, Bahçesehir University, Medical School, Istanbul, Turkey
4 Department of Pathology, Marmara University, Istanbul, Turkey

Date of Submission23-Jan-2014
Date of Decision23-Jan-2014
Date of Acceptance25-Jan-2014
Date of Web Publication7-Mar-2014

Correspondence Address:
Murat Sakir Eksi
Department of Orthopedic Surgery, Spine Center, University of California, San Francisco, CA
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.128322

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How to cite this article:
Eksi MS, Hasanov T, Yilmaz B, Akakin A, Bayri Y, Bozkurt SU, Kiliç T. Isolated metastasis of breast cancer to the pituitary gland. Neurol India 2014;62:70-1

How to cite this URL:
Eksi MS, Hasanov T, Yilmaz B, Akakin A, Bayri Y, Bozkurt SU, Kiliç T. Isolated metastasis of breast cancer to the pituitary gland. Neurol India [serial online] 2014 [cited 2018 Jul 19];62:70-1. Available from: http://www.neurologyindia.com/text.asp?2014/62/1/70/128322


Sir,

A 56-year-old female patient presented with paracetamol-resistant headache of 3 months duration and gait disturbance of 1 week. She had been on levothyroxin medication for Hashimato's thyroiditis since 10 years. She had a left radical mastectomy operation for invasive ductal carcinoma 7 years earlier and post-operative radiotherapy and chemotherapy. During these 7 years, no local or distant recurrence of tumor had been observed. On neurological examination visual field was intact and visual acuity was 20/40 for right eye and 20/20 for left eye. On tandem-walk, gait was improper. Brain magnetic resonance imaging (MRI) showed a sellar mass lesion extending to the suprasellar area. It was isointense to brain on both T1-and T2-weighted scans [Figure 1]a and b-white arrows]. Contrast administration, showed homogenous enhancement of the lesion [[Figure 1]c-white arrows]. Hormone profile was normal. Due to tumor extension out of sellar region, we chose transcranial approach for surgery. Frozen result was metastatic lesion. The lesion was debulked. Post-operative period was uneventful. Histopathology revealed small fragments consisted of medium sized tumor cells doing incomplete acinar formation and also diffusely infiltrating single tumor cells in the fibrous tissue [Figure 2]a. Immunostaining for pan-cytokeratin was strongly positive [Figure 2]b. Hormone receptors were found to be negative for both estrogen and progesterone. Positron emission tomography-computed tomography for whole body and scintigraphy for skeletal system were negative. At 1 week after the index surgery, radiosurgery treatment was given with Leksell Gamma Knife, Model B (Elekta Instruments AB, Stockholm, Sweden). 11 Gy for 50% isodose area [22 Gy maximal dose, [Figure 3]. She was referred to her regular oncologist for multidisciplinary follow-up.
Figure 1: Pre-operative magnetic resonance imaging shows the sellar mass extending to the suprasellar region. It is isointense to brain on both coronal T1-weighted (a) and T2-weighted (b) sections. (c) Coronal contrast enhanced T1-weighted image shows homogenous enhancement of the mass without non-enhancing necrotic portion (white arrows)

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Figure 2: (a) Small fragments consisting of medium sized tumor cells with small nucleoli (H and E, ×400). (b) Tumor cells stain positive with pan-cytokeratin, immunohistochemically (pan-cytokeratin, ×200)

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Figure 3: On post-operative 7th day, radiosurgery treatment was given to the residual tumor bed

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Other than pituitary adenomas, tumors present in sellar and suprasellar regions include craniopharyngiomas, germ cell tumors, optic pathway gliomas, hamartomas, dermoids, epidermoids, lipomas, choristomas and metastases. [1] Metastasis to pituitary gland is very rare (1% of all pituitary neoplasms) and presents with similar clinical presentation as pituitary adenoma. [1],[2],[3] Mainly lung in men and breast in women are the primary sites for metastasis. [3],[4] Radiology is usually not sufficient to differentiate metastatic lesions from pituitary adenomas. [1],[2],[4],[5] In our case, brain MRI depicted a sellar lesion extending to the suprasellar region, enhanced uniformly after intravenous contrast material. There was no necrotic area, ring enhancement or bony erosion. Furthermore, the clinical progress was insidious. She had been operated for breast carcinoma 7 years before this presentation. Histopathology and immunohistochemical studies helped to make the correct diagnosis. MIB-1 value was very high and compatible with metastatic lesion. [2] Immunostaining was strongly positive for pan-cytokeratin and negative for synaptophysin. Pan-cytokeratin suggested the relationship of the current pathology with the previous breast neoplasm. Our case is unique that there was neither a local recurrence nor distant metastasis. Due to suprasellar invasion of the tumor and frozen diagnosis of metastasis, we preferred debulking surgery with post-operative adjuvant stereotactic radiosurgery.


 » Acknowledgments Top


We thank to Gülcan Davulcu and Ardinc Arpinar for their technical support in preparing the manuscript in this study.

 
 » References Top

1.Smith JK. Parasellar tumors: Suprasellar and cavernous sinuses. Top Magn Reson Imaging 2005;16:307-15.  Back to cited text no. 1
    
2.Luu ST, Billing K, Crompton JL, Blumbergs P, Lee AW, Chen CS. Clinicopathological correlation in pituitary gland metastasis presenting as anterior visual pathway compression. J Clin Neurosci 2010;17:790-3.  Back to cited text no. 2
    
3.Spinelli GP, Lo Russo G, Miele E, Prinzi N, Tomao F, Antonelli M, et al. Breast cancer metastatic to the pituitary gland: A case report. World J Surg Oncol 2012;10:137.  Back to cited text no. 3
    
4.Poursadegh Fard M, Borhani Haghighi A, Bagheri MH. Breast cancer metastasis to pituitary infandibulum. Iran J Med Sci 2011;36:141-4.  Back to cited text no. 4
    
5.Bret P, Jouvet A, Madarassy G, Guyotat J, Trouillas J. Visceral cancer metastasis to pituitary adenoma: Report of two cases. Surg Neurol 2001;55:284-90.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]

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