title: Prolactin-Secreting Pituitary Carcinoma with Dural Metastasis: Diagnosis, Treatment, and Future Directions.
abstract: BACKGROUND
  Pituitary carcinoma is extremely rare, representing approximately 0.2% of all surgically resected pituitary neoplasms. It is thought to arise from World Health Organization grade II (atypical) pituitary adenomas. Pituitary carcinoma is defined by metastasis; it is otherwise indistinguishable from atypical pituitary adenomas, which can be considered carcinoma in situ. Pituitary carcinoma is difficult to diagnose and treat and is associated with poor long-term outcomes.
  
  
  METHODS
  A 75-year-old man presented with a highly aggressive and treatment-refractory atypical prolactinoma that transformed into a prolactin carcinoma. Although the patient experienced early hormonal and surgical remission and local tumor control after tumor resection and fractionated radiation, isolated dural-based metastases were subsequently noted following gradual elevation in serum prolactin despite ongoing dopamine agonist therapy. En bloc resection was performed of the pathology-confirmed, prolactin-staining dural metastases. At 1-year follow-up, there was no further evidence of metastatic disease, and normalization of serum prolactin was observed.
  
  
  CONCLUSIONS
  Long-term surveillance using serum prolactin as a tumor biomarker and correlation to imaging studies were critical for the diagnosis and interval screening for recurrence. This technique can be applied to all secretory atypical pituitary adenomas to improve early detection of potential metastasis. Further research, especially of genetic and epigenetic characteristics, could readily improve the diagnosis and treatment of pituitary carcinomas.
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA. Electronic address: jseltzer@gmail.com.
authors.forename: Justin
authors.initials: J
authors.lastname: Seltzer
authors.affiliation: Division of Endocrinology, Department of Medicine, Keck School of Medicine of USC, Los Angeles, California, USA; USC Pituitary Center, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Carmichael
authors.affiliation: Division of Neuropathology, Department of Pathology, Keck School of Medicine of USC, Los Angeles, California, USA; USC Pituitary Center, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Commins
authors.affiliation: Division of Neuroradiology, Department of Radiology, Keck School of Medicine of USC, Los Angeles, California, USA; USC Pituitary Center, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Chia-Shang Jason
authors.initials: CS
authors.lastname: Liu
authors.affiliation: Division of Endocrinology, Department of Medicine, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Omura
authors.affiliation: Department of Radiation Oncology, Keck School of Medicine of USC, Los Angeles, California, USA; USC Pituitary Center, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA; USC Pituitary Center, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Zada
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery; D011388:Prolactin / Q000097:blood*; D015175:Prolactinoma / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*
chemical_list: D011388:Prolactin
keywords: Dural metastasis; Metastasis; Pituitary; Pituitary carcinoma; Prolactin; Prolactinoma