title: Pituitary carcinoma with endolymphatic sac metastasis.
abstract: Pituitary carcinoma is characterized by the presence of a metastatic lesion(s) in a location non-contiguous with the original pituitary tumor. The mechanism(s) of malignant transformation are not known. A 15 year-old male was diagnosed in 1982 with a pituitary macroadenoma and acromegaly (random GH 67 ng/ml and no suppression by oral glucose). His prolactin was normal between 18 and 23 ng/ml. Transcranial resection in July 1983 was followed by radiation therapy. The tumor was immunopositive for GH and prolactin. The proliferation MIB-1 index was 0-1%. With aqueous Octreotide 100 mcg 4× daily both GH and IGF-1 became normal. The patient was lost to follow-up and was treated by his local physician. In 2001, his IGF-1 level was 1271 ng/ml, and his random GH was 1.8-2.4 ng/ml by ILMA despite progressive increase in the dose of Sandostatin LAR to 140 mg/month in divided doses. Prolactin remained normal or minimally increased between 15 and 25 ng/ml. In 2009 he was diagnosed with the tumor in the location of left endolymphatic sac. Histological examination showed low grade pituitary carcinoma strongly immunopositive for prolactin but negative for GH. MIB-1 antibody labeled 0-5% cells. In 2012 endoscopic resection of the pituitary tumor remnant was attempted. Immunohistochemical stains were strongly immunopositive for both prolactin and GH, similar to his original pituitary tumor. The MIB-1 proliferation index was low from 0 to 1%. To our knowledge this is the first case of pituitary carcinoma in the endolymphatic sac region. The dichotomy between the cell population of the pituitary lesion (GH/prolactin producing) and the metastasis (purely prolactin-producing) may suggest that the metastatic pituitary lesion derived from a clone distinct from the original one.
authors: Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA.
authors: Irida
authors: I
authors: Balili
authors: Steven
authors: S
authors: Sullivan
authors: Paul
authors: P
authors: Mckeever
authors: Ariel
authors: A
authors: Barkan
mesh_terms: D000293:Adolescent; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D004428:Ear Neoplasms / Q000473:pathology / Q000556:secondary*; D004711:Endolymphatic Duct / Q000473:pathology; D004712:Endolymphatic Sac / Q000473:pathology*; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D015282:Octreotide / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000473:pathology*; D015175:Prolactinoma / Q000473:pathology* / Q000556:secondary*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D019394:Ki-67 Antigen; D015282:Octreotide
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