title: Pituitary Carcinoma in a Patient with an SDHB Mutation.
abstract: We present the first case of pituitary carcinoma occurring in a patient with a succinate dehydrogenase subunit B (SDHB) mutation and history of paraganglioma. She was initially treated for a glomus tumour with external beam radiotherapy. Twenty-five years later, she was diagnosed with a non-functioning pituitary adenoma, having developed bitemporal hemianopia. Recurrence of the pituitary lesion (Ki-67 10% and p53 overexpressed) occurred 5 years after her transsphenoidal surgery, for which she underwent two further operations followed by radiotherapy. Histology showed large cells with vacuolated clear cytoplasm with positive immunostaining for steroidogenic factor 1 (SF1) and negative staining for pituitary hormones. Four years after the pituitary radiotherapy, two metastatic deposits were identified: a foramen magnum lesion and an intradural extra-medullary cervical lesion at the level of C3/C4. There was also significant growth of the primary pituitary lesion with associated visual deterioration. A biopsy of the foramen magnum lesion, demonstrating cells with vacuolated, clear cytoplasm and positive SF1 staining confirmed a pituitary carcinoma, for which she was commenced on temozolomide chemotherapy. There was dramatic clinical improvement after three cycles and reduction in the size of the lesions was observed following six cycles of temozolomide, and further shrinkage after 10 cycles. The plan is for a total of 12 cycles of temozolomide chemotherapy. SDH mutation-related pituitary tumours have an aggressive phenotype which, in this case, led to metastatic disease. SF1 immunostaining was helpful to identify the tissue origin of the metastatic deposit and to confirm the pituitary carcinoma.
authors.affiliation: Centre of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
authors.forename: Nicola
authors.identifier: http://orcid.org/0000-0003-2382-9711
authors.initials: N
authors.lastname: Tufton
authors.affiliation: Division of Neuroscience, University of Manchester, Manchester, UK.
authors.forename: Federico
authors.initials: F
authors.lastname: Roncaroli
authors.affiliation: Centre of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
authors.forename: Irene
authors.initials: I
authors.lastname: Hadjidemetriou
authors.affiliation: Centre of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
authors.forename: Mary N
authors.initials: MN
authors.lastname: Dang
authors.affiliation: Centre of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
authors.forename: Judit
authors.initials: J
authors.lastname: Dénes
authors.affiliation: Centre of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Guasti
authors.affiliation: Department of Neuropathology, University College London Hospitals, WC1E 6BT, London, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Thom
authors.affiliation: Department of Neurosurgery, University College London Hospitals, WC1E 6BT, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Powell
authors.affiliation: Department of Endocrinology, University College London Hospitals, WC1E 6BT, London, UK.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Baldeweg
authors.affiliation: Department of Oncology, University College London Hospitals, WC1E 6BT, London, UK.
authors.forename: Naomi
authors.initials: N
authors.lastname: Fersht
authors.affiliation: Centre of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK. m.korbonits@qmul.ac.uk.
authors.forename: Márta
authors.initials: M
authors.lastname: Korbonits
mesh_terms: D000236:Adenoma / Q000235:genetics* / Q000473:pathology; D000328:Adult; D004428:Ear Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D009154:Mutation; D009364:Neoplasm Recurrence, Local / Q000235:genetics / Q000473:pathology; D009378:Neoplasms, Multiple Primary / Q000235:genetics / Q000473:pathology; D010236:Paraganglioma, Extra-Adrenal / Q000473:pathology; D010911:Pituitary Neoplasms / Q000235:genetics* / Q000473:pathology; D013385:Succinate Dehydrogenase / Q000235:genetics*
chemical_list: C108095:SDHB protein, human; D013385:Succinate Dehydrogenase
keywords: Paraganglioma; Pituitary carcinoma; SDHB; Succinate dehydrogenase; Temozolomide