Osteogenic sarcoma of the sella after radiation treatment of a pituitary adenoma.
OBJECTIVE
To report an uncommon case of osteogenic sarcoma of the sella turcica after radiation treatment of a pituitary adenoma.


METHODS
We present the clinical history, physical findings, laboratory data, imaging studies, and pathologic findings in a patient found to have osteogenic sarcoma of the sella after radiation therapy for a nonfunctioning pituitary adenoma.


RESULTS
Six years after transsphenoidal resection and postoperative fractionated radiation therapy for a nonfunctioning pituitary adenoma that extended to the cavernous sinus, a 45-year-old man presented with a sinus infection, diplopia, and ophthalmoplegia of the right eye. A computed tomographic scan of the head showed a mass in the sella with involvement of the optic chiasm and right cavernous sinus. Transsphenoidal resection and debulking of the tumor revealed an osteogenic sarcoma. The patient was discharged from the hospital with residual diplopia and ophthalmoplegia. He was treated with levothyroxine, testosterone, and hydrocortisone. Six weeks later, the patient was readmitted after he was found unresponsive, and computed tomographic scans disclosed a massive cerebrovascular accident. He died a few days later.


CONCLUSIONS
Osteogenic sarcoma is a rare, late complication of radiation treatment of pituitary adenoma. Although radiotherapy remains an effective adjunctive treatment in patients with pituitary adenomas, particularly those with residual or recurrent tumor, potential complications must be acknowledged.
Bembo
Shirley A
SA
Department of Medicine, State University of New York, Stony Brook University Hospital and Medical Center, Stony Brook, New York 11794-8154, USA.
Pasmantier
RoseMarie
R
Davis
Raphael P
RP
Xiong
Zhenggang
Z
Weiss
Tamara E
TE
D000236:Adenoma / Q000628:therapy; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000209:etiology* / Q000628:therapy; D019635:Neurosurgical Procedures / Q000379:methods; D012516:Osteosarcoma / Q000209:etiology* / Q000628:therapy; D010911:Pituitary Neoplasms / Q000628:therapy; D011878:Radiotherapy / Q000009:adverse effects*; D012658:Sella Turcica; D012888:Skull Neoplasms / Q000209:etiology* / Q000628:therapy