Treatment of a pituitary metastasis from a neuroendocrine tumour: case report and literature review.
Herein we report a rare case of a pituitary metastasis from a neuroendocrine tumour mimicking an adenoma. Moreover, starting from this unusual case, the relevant literature concerning the diagnosis and management of patients with metastasis at pituitary level is reviewed. A 69-year-old woman was admitted to our Unit for severe headache, diplopia, and critical visual field impairment. MRI showed a large pituitary mass compressing the optic chiasm and infiltrating the cavernous sinus. Trans-sphenoidal biopsy revealed a pituitary metastasis from a neuroendocrine tumour, in line with the multiple liver lesions that were already considered metastases from an ileal primary neuroendocrine tumour. In vitro receptor characterisation of both pituitary and liver tissues by immunohistochemistry showed a heterogeneous somatostatin receptor subtype pattern, with a predominant expression of sst(2) within the pituitary lesion. However, the liver metastasis receptor profile was completely different from the pituitary. Octreotide LAR was administered first, followed by receptor radiometabolic therapy with radiolabelled somatostatin analogues ((90)Y-DOTATOC and (177)Lu-DOTATATE). After 16 months, MRI showed a significant shrinkage of the sellar mass. Moreover, disappearance of diplopia and visual defects, together with a considerable improvement in quality of life were gradually recorded. To our knowledge, this is the first case of combined treatment using "cold" and radiolabelled octreotide in a pituitary metastasis from a neuroendocrine tumour.
Goglia
Umberto
U
Department of Endocrinological & Medical Sciences and Center of Excellence for Biomedical Research, University of Genova, Viale Benedetto XV, 6, Genova 16132, Italy. ferone@unige.it
Ferone
Diego
D
Sidoti
Marilena
M
Spaziante
Renato
R
Dadati
Patrizia
P
Ravetti
Jean-Luis
JL
Villa
Giuseppe
G
Bodei
Lisa
L
Paganelli
Giovanni
G
Minuto
Francesco
F
Giusti
Massimo
M
D000236:Adenoma / Q000175:diagnosis; D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001706:Biopsy; D003692:Delayed-Action Preparations; D003937:Diagnosis, Differential; D004172:Diplopia / Q000209:etiology / Q000628:therapy; D005260:Female; D006261:Headache / Q000209:etiology / Q000628:therapy; D006801:Humans; D007078:Ileal Neoplasms / Q000473:pathology*; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000556:secondary; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000150:complications / Q000556:secondary / Q000628:therapy*; D015282:Octreotide / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D009942:Organometallic Compounds / Q000627:therapeutic use*; D010911:Pituitary Neoplasms / Q000150:complications / Q000556:secondary / Q000628:therapy*; D011788:Quality of Life; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D018931:Antineoplastic Agents, Hormonal; D003692:Delayed-Action Preparations; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; C496730:90Y-octreotide, DOTA-Tyr(3)-; C447941:lutetium Lu 177 dotatate; D015282:Octreotide