Metastatic melanoma to the pituitary gland.
BACKGROUND
Metastasis to the pituitary gland is unusual, and occurs most often in patients with carcinomas of the breast or lung. Despite its propensity for spread to the brain, metastatic melanoma has rarely been described within the sella.


METHODS
We report two cases of malignant melanoma pathologically confirmed within the pituitary, both metastatic from a primary site on the chest wall. In each patient, transsphenoidal resection of the tumor was incomplete and each received local radiotherapy after surgery.


RESULTS
One patient recurred quickly and developed brain metastasis as well. He died four months after resection of the pituitary metastasis, but the second patient survived six months without recurrence. As intrasellar metastasis portends widespread systemic disease and may be synchronous with parenchymal brain metastasis, survival in such patients is limited regardless of adjunctive therapy.


CONCLUSIONS
Such cases are likely to arise more commonly in future due to the increasing incidence of melanoma. Identifying them by imaging alone is difficult due to inconsistent signal characteristics on MRI (as shown by these cases) and the confusion introduced by any associated intratumoral hemorrhage.
McCutcheon
Ian E
IE
Departments of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Waguespack
Steven G
SG
Fuller
Gregory N
GN
Couldwell
William T
WT
D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D017809:Fatal Outcome; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures; D010902:Pituitary Gland / Q000473:pathology* / Q000601:surgery; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D012658:Sella Turcica / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D035441:Thoracic Wall / Q000473:pathology