title: Pituitary carcinoma with malignant growth from first presentation and fulminant clinical course--case report and review of the literature.
abstract: BACKGROUND
  Although pituitary adenomas are common, pituitary carcinoma is a very rare condition.
  
  
  OBJECTIVE
  We report on a 48-yr-old male presenting with pituitary carcinoma with malignant growth from the beginning and a fulminant clinical course and give an overview of the previously reported cases, paying special attention to clinical and histological parameters that may predict the clinical course.
  
  
  METHODS
  We performed a MEDLINE search for previously published cases of pituitary carcinoma and analyzed the clinical, laboratory, and radiological findings.
  
  
  RESULTS
  Ki-67 index and the number of metastatic diseases found on postmortem examination were significantly increased in patients with no treatment response compared to those with some treatment response (P = 0.03 and P = 0.02, respectively). In contrast, time to occurrence of metastatic disease and time to death were significantly shortened in patients with no treatment response (P = 0.01 and P = 0.02, respectively). No differences were found between the two groups for gender distribution, tumor size, mitotic activity assessed as the number of mitotic figures per 10 high-power fields, and number of locations of metastatic disease.
  
  
  CONCLUSIONS
  Frequently relapsing, invasive adenoma should raise a suspicion of a malignant disease. Clinically only the presence of metastases is a criterion of malignancy. A high Ki-67 index in the pituitary carcinoma and early manifestation of metastatic disease appear to predict rapid disease progression.
authors.affiliation: Department of Endocrinology, University Hospital of Tübingen, 72076 Tübingen, Germany.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Dudziak
authors.forename: Jürgen
authors.initials: J
authors.lastname: Honegger
authors.forename: Antje
authors.initials: A
authors.lastname: Bornemann
authors.forename: Marius
authors.initials: M
authors.lastname: Horger
authors.forename: Karsten
authors.initials: K
authors.lastname: Müssig
mesh_terms: D002277:Carcinoma / Q000473:pathology*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000473:pathology*; D010911:Pituitary Neoplasms / Q000473:pathology*