title: Pituitary carcinoma recurrent to the lumbar intradural extramedullary space: case report.
abstract: BACKGROUND
  Pituitary tumors are rare, and pituitary carcinomas are rarer still. Prognosis is poor, with less than 50% of patients surviving past 1 year after diagnosis. In this case of spinal metastasis from an adrenocorticotropic hormone-secreting pituitary carcinoma, the intradural extramedullary metastases recurred in the same lumbar area 6 years apart.
  
  
  RESULTS
  Fourteen years prior to presentation in our clinic, a 48-year-old woman was diagnosed with pituitary adenoma which was treated with resection followed by radiation. Eight years later, an intradural extramedullary spinal drop metastasis at L2-L3 was again treated with resection and radiation. Three years later, magnetic resonance imaging (MRI) revealed a mass encasing the right carotid artery, which was treated for 1 year with chemotherapy using temozolomide (Temodar). Three years later, MRI showed intradural extramedullary metastases at the L3-L4 intervertebral disc space and behind the L3 vertebral body; treatment was again resection followed by radiation. Back pain and weakness resolved after surgery and her neurological examination returned to baseline. There was no evidence of recurrence 1 year after surgery.
  
  
  CONCLUSIONS
  In this unusual case, this pituitary carcinoma metastasized twice in 6 years to virtually the same intradural extramedullary lumbar region. Surgical resection of these masses aided in relieving neurological symptoms and prolonging life.
authors.affiliation: Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS 66160, USA. parnold@kumc.edu
authors.forename: Paul M
authors.initials: PM
authors.lastname: Arnold
authors.forename: Denesh
authors.initials: D
authors.lastname: Ratnasingam
authors.forename: Maura F
authors.initials: MF
authors.lastname: O'Neil
authors.forename: Philip L
authors.initials: PL
authors.lastname: Johnson
mesh_terms: D002277:Carcinoma / Q000473:pathology*; D005260:Female; D006801:Humans; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000473:pathology*; D013120:Spinal Cord Neoplasms / Q000556:secondary*