Skip to main content

Advertisement

SpringerLink
Log in

Sarcoma of the sella after radiotherapy for pituitary adenoma

  • Case Report
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Secondary malignancies are infrequent sequelae of pituitary radiotherapy. The goal of the present case study is to analyze clinical features of a selected group of cases to define the special characteristics of these tumors. We report the illustrative case of a 38-year-old man with acromegaly who had transsphenoidal surgery and radiotherapy 7 years before presenting with a sellar high-grade sarcoma. Transsphenoidal and transcranial resection, as well as repeated gamma knife radiosurgery, could not prevent tumor progression and development of meningiosis sarcomatosa. We performed a thorough search of the literature and reviewed numerous publications and reports on primary and secondary sarcomas of the sella. Our search revealed 51 cases of mesenchymal malignancies after sellar radiotherapy. For further analysis, we identified and selected a group of patients based on the criteria for studying radiation-induced tumors as described by Cahan.Compared to the surgically treated group, secondary sarcomas of the sella are more frequent in patients who have had radiotherapy. These tumors occur at normal dose schedules with long latencies. Their growth is very aggressive and they may develop meningiosis sarcomatosa. Until now, no treatment modalities have been able to stop the progression of these neoplasms. Radiation-induced sarcoma is a rare sequela of pituitary radiotherapy. It is important for the treating physician to keep in mind the possibility of post-radiation sarcoma development. Additionally, one must include these tumors into the differential diagnosis in pituitary patients presenting with tumor recurrence more than 5 years after radiotherapy in combination with a secondary lack of hormonal activity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Ahmad K, Fayos JV (1978) Pituitary fibrosarcoma secondary to radiation therapy. Cancer 42:107–110

    Article  CAS  PubMed  Google Scholar 

  2. Ahmed M, Kanaan I, Rifai A, Tulbah A, Ghannam N (1997) An unusual treatment-related complication in a patient with growth hormone-secreting pituitary tumor. J Clin Endocrinol Metab 82:2816–2820

    Article  CAS  PubMed  Google Scholar 

  3. Amendola BE, Amendola MA, McClatchey KD, Miller CH Jr (1989) Radiation-associated sarcoma: a review of 23 patients with postradiation sarcoma over a 50-year period. Am J Clin Oncol 12:411–415

    Article  CAS  PubMed  Google Scholar 

  4. Amine AR, Sugar O (1976) Suprasellar osteogenic sarcoma following radiation for pituitary adenoma. Case report. J Neurosurg 44:88–91

    Article  CAS  PubMed  Google Scholar 

  5. Anderson WR, Cameron JD, Tsai SH (1980) Primary intracranial leiomyosarcoma. Case report with ultrastructural study. J Neurosurg 53:401–405

    Article  CAS  PubMed  Google Scholar 

  6. Arita K, Sugiyama K, Tominaga A, Yamasaki F (2001) Intrasellar rhabdomyosarcoma: case report. Neurosurgery 48:677–680

    Article  CAS  PubMed  Google Scholar 

  7. Averback P (1978) Mixed intracranial sarcomas: rare forms and a new association with previous radiation therapy. Ann Neurol 4:229–233

    Article  CAS  PubMed  Google Scholar 

  8. Bliss P, Kerr GR, Gregor A (1994) Incidence of second brain tumours after pituitary irradiation in Edinburgh 1962-1990. Clin Oncol (R Coll Radiol) 6:361–363

    CAS  Google Scholar 

  9. Boelaert K, Gittoes NJ (2001) Radiotherapy for non-functioning pituitary adenomas. Eur J Endocrinol 144:569–575

    Article  CAS  PubMed  Google Scholar 

  10. Bots GT, Tijssen CC, Wijnalda D, Teepen JL (1988) Alveolar soft part sarcoma of the pituitary gland with secondary involvement of the right cerebral ventricle. Br J Neurosurg 2:101–107

    Article  CAS  PubMed  Google Scholar 

  11. Brada M, Ford D, Ashley S, Bliss JM, Crowley S, Mason M, Rajan B, Traish D (1992) Risk of second brain tumour after conservative surgery and radiotherapy for pituitary adenoma. BMJ 304:1343–1346

    Article  CAS  PubMed  Google Scholar 

  12. Cahan WG, Woodard HQ et al (1948) Sarcoma arising in irradiated bone; report of 11 cases. Cancer 1:3–29

    Article  CAS  PubMed  Google Scholar 

  13. Chang CH, Pool JL (1967) The radiotherapy of pituitary chromophobe adenomas: an evaluation of indication, technic, and result. Radiology 89:1005–1016

    CAS  PubMed  Google Scholar 

  14. Chang SM, Barker FG 2nd, Larson DA, Bollen AW, Prados MD (1995) Sarcomas subsequent to cranial irradiation. Neurosurgery 36:685–690

    Article  CAS  PubMed  Google Scholar 

  15. Coppeto JR, Roberts M (1979) Fibrosarcoma after proton-beam pituitary ablation. Arch Neurol 36:380–381

    CAS  PubMed  Google Scholar 

  16. Dallasta LM, Martinez J, Nichols L, Hanzlick R (1999) Pathologic findings in a transplant donor. Arch Intern Med 159:2115–2116

    Article  CAS  PubMed  Google Scholar 

  17. del Regato JA (1964) Eosinophilic adenoma of pituitary with sarcomatous changes. Cancer Sem 3:77–80

    Google Scholar 

  18. Fisher BJ, Gaspar LE, Noone B (1993) Radiation therapy of pituitary adenoma: delayed sequelae. Radiology 187:843–846

    CAS  PubMed  Google Scholar 

  19. Gerlach H, Janisch W (1979) Intracranial sarcoma after radiotherapy of a pituitary adenoma. Zentralbl Neurochir 40:131–136

    CAS  PubMed  Google Scholar 

  20. Gnanalingham KK, Chakraborty A, Galloway M, Revesz T, Powell M (2002) Osteosarcoma and fibrosarcoma caused by postoperative radiotherapy for a pituitary adenoma. Case report. J Neurosurg 96:960–963

    Article  PubMed  Google Scholar 

  21. Goldberg MB, Sheline GE, Malamud N (1963) Malignant intracranial neoplasms, following radiation therapy for acromegaly. Radiology 80:465–470

    CAS  PubMed  Google Scholar 

  22. Gonzalez-Vitale JC, Slavin RE, McQueen JD (1976) Radiation-induced intracranial malignant fibrous histiocytoma. Cancer 37:2960–2963

    Article  CAS  PubMed  Google Scholar 

  23. Greenhouse AH (1964) Pituitary Sarcoma; a Possible Consequence of Radiation. JAMA 190:269–273

    CAS  PubMed  Google Scholar 

  24. Iishi H, Baba M, Tatsuta M, Okuda S, Taniguchi H (1992) Enhancement of dopaminergic agonist bromocriptine of gastric carcinogenesis induced by N-methyl-N'-nitro-N-nitrosoguanidine in Wistar rats. Br J Cancer 65:351–354

    CAS  PubMed  Google Scholar 

  25. Isobe K, Ohta M, Yasuda S, Uno T, Hara R, Machida N, Saeki N, Yamaura A, Shigematsu N, Ito H (2000) Postoperative radiation therapy for pituitary adenoma. J Neurooncol 48:135–140

    Article  CAS  PubMed  Google Scholar 

  26. Jalalah S, Kovacs K, Horvath E, Couldwell W, Weiss MH, Ezrin C (1987) Rhabdomyosarcoma in the region of the sella turcica. Acta Neurochir (Wien) 88:142–146

    Article  CAS  Google Scholar 

  27. Jones A (1991) Radiation oncogenesis in relation to the treatment of pituitary tumours. Clin Endocrinol (Oxf) 35:379–397

    Article  CAS  Google Scholar 

  28. Kleinsasser O, Albrecht H (1957) Zur Kenntnis der Osteosarkome des Stirn- und Keilbeines. Arch Ohren Heilk 170:595–603

    Article  Google Scholar 

  29. Kojima G (1979) Pituitary tumour developing subsequent to radiation therapy of pituitary. Igaku No Ayumi 108:601–602

    Google Scholar 

  30. Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Applegate G, Sutton ML (1989) Hypopituitarism following external radiotherapy for pituitary tumours in adults. Q J Med 70:145–160

    CAS  PubMed  Google Scholar 

  31. Lopes MB, Lanzino G, Cloft HJ, Winston DC, Vance ML, Laws ER Jr (1998) Primary fibrosarcoma of the sella unrelated to previous radiation therapy. Mod Pathol 11:579–584

    CAS  PubMed  Google Scholar 

  32. Martin WH, Cail WS, Morris JL, Constable WC (1980) Fibrosarcoma after high energy radiation therapy for pituitary adenoma. AJR Am J Roentgenol 135:1087–1090

    CAS  PubMed  Google Scholar 

  33. Massier A, Scheithauer BW, Taylor HC, Clark C, Llerena L (2007) Sclerosing epithelioid fibrosarcoma of the pituitary. Endocr Pathol 18:233–238

    Article  PubMed  Google Scholar 

  34. McCollough WM, Marcus RB Jr, Rhoton AL Jr, Ballinger WE, Million RR (1991) Long-term follow-up of radiotherapy for pituitary adenoma: the absence of late recurrence after greater than or equal to 4500 cGy. Int J Radiat Oncol Biol Phys 21:607–614

    CAS  PubMed  Google Scholar 

  35. Meredith JM, Mandeville FB, Kay S (1960) Osteogenic sarcoma of the skull following roentgen-ray therapy for benign pituitary tumor. J Neurosurg 17:792–799

    Article  Google Scholar 

  36. Miller RC, Foote RL, Coffey RJ, Gorman DA, Earle JD, Schomberg PJ, Kline RW (1997) The role of stereotactic radiosurgery in the treatment of malignant skull base tumors. Int J Radiat Oncol Biol Phys 39:977–981

    CAS  PubMed  Google Scholar 

  37. Mindermann T, Kovacs K, Wilson CB (1994) Changes in the immunophenotype of recurrent pituitary adenomas. Neurosurgery 35:39–44

    Article  CAS  PubMed  Google Scholar 

  38. Minniti G, Traish D, Ashley S, Gonsalves A, Brada M (2005) Risk of second brain tumor after conservative surgery and radiotherapy for pituitary adenoma: update after an additional 10 years. J Clin Endocrinol Metab 90:800–804

    Article  CAS  PubMed  Google Scholar 

  39. Nagasaka T, Nakashima N, Furui A, Wakabayashi T, Yoshida J (1998) Sarcomatous transformation of pituitary adenoma after bromocriptine therapy. Hum Pathol 29:190–193

    Article  CAS  PubMed  Google Scholar 

  40. Nagatani M, Ikeda T, Otsuki H, Mizuta T, Mori S, Ushio Y, Hayakawa T, Mogami H, Matsumoto K, Mori H (1984) Sellar fibrosarcoma following radiotherapy for prolactinoma. No Shinkei Geka 12:339–346

    CAS  PubMed  Google Scholar 

  41. Newton TH, Burhenne HJ, Palubinskas AJ (1962) Primary carcinoma of the pituitary. Am J Roentgenol Radium Ther Nucl Med 87:110–120

    CAS  PubMed  Google Scholar 

  42. Nishio S, Morioka T, Inamura T, Takeshita I, Fukui M, Sasaki M, Nakamura K, Wakisaka S (1998) Radiation-induced brain tumours: potential late complications of radiation therapy for brain tumours. Acta Neurochir (Wien) 140:763–770

    Article  CAS  Google Scholar 

  43. Niwa J, Hashi K, Minase T (1996) Radiation induced intracranial leiomyosarcoma: its histopathological features. Acta Neurochir (Wien) 138:1470–1471

    Article  CAS  Google Scholar 

  44. Pages A, Pages M, Ramos J, Benezech J (1986) Radiation-induced intracranial fibrochondrosarcoma. J Neurol 233:309–310

    Article  CAS  PubMed  Google Scholar 

  45. Pieterse S, Dinning TA, Blumbergs PC (1982) Postirradiation sarcomatous transformation of a pituitary adenoma: a combined pituitary tumor. Case report. J Neurosurg 56:283–286

    Article  CAS  PubMed  Google Scholar 

  46. Powell HC, Marshall LF, Ignelzi RJ (1977) Post-irradiation pituitary sarcoma. Acta Neuropathol 39:165–167

    Article  CAS  PubMed  Google Scholar 

  47. Prabhu SS, Aldape KD, Gagel RF, Benjamin RS, Trent JC, McCutcheon IE (2003) Sarcomatous change after sellar irradiation in a growth hormone-secreting pituitary adenoma. Can J Neurol Sci 30:378–383

    PubMed  Google Scholar 

  48. Reichenthal E, Cohen ML, Manor CR, Marshak G, Matz S, Shalit MN (1981) Primary osteogenic sarcoma of the sellar region. Case report. J Neurosurg 55:299–302

    Article  CAS  PubMed  Google Scholar 

  49. Romero FJ, Ortega A, Ibarra B, Piqueras J, Rovira M (1989) Post-radiation cranial malignant fibrous histiocytoma studied by CT. Comput Med Imaging Graph 13:191–194

    Article  CAS  PubMed  Google Scholar 

  50. Ron E, Modan B, Boice JD Jr, Alfandary E, Stovall M, Chetrit A, Katz L (1988) Tumors of the brain and nervous system after radiotherapy in childhood. N Engl J Med 319:1033–1039

    Article  CAS  PubMed  Google Scholar 

  51. Rubinstein LJ (1972) Tumours of the central nervous system, in Atlas of Tumour Pathology, Vol. 6, 2nd Series. Armed Forces Institute of Pathology Fascicle, Washington, p 19

    Google Scholar 

  52. Sasaki R, Murakami M, Okamoto Y, Kono K, Yoden E, Nakajima T, Nabeshima S, Kuroda Y (2000) The efficacy of conventional radiation therapy in the management of pituitary adenoma. Int J Radiat Oncol Biol Phys 47:1337–1345

    CAS  PubMed  Google Scholar 

  53. Sato K, Hayashi M, Komai T, Kubota T, Kawano H, Handa Y (1990) Clinical and histological study of pituitary fibrosarcoma following radiotherapy for pituitary adenoma. Case report. Neurol Med Chir (Tokyo) 30:888–892

    CAS  Google Scholar 

  54. Shi T, Farrell MA, Kaufmann JC (1984) Fibrosarcoma complicating irradiated pituitary adenoma. Surg Neurol 22:277–284

    Article  CAS  PubMed  Google Scholar 

  55. Shin H, Namba H, Ishige N, Ohsato K, Nakamura T, Yamaura A, Makino H (1980) Pituitary fibrosarcoma secondary to radiation therapy for the treatment of chromophobe adenoma (author's transl). No Shinkei Geka 8:605–614

    CAS  PubMed  Google Scholar 

  56. Sindou M, Daher A, Vighetto A, Goutelle A (1989) Parasellar chondrosarcoma: report of a case operated on through a pteriono-temporal approach and review of the literature. Neurochirurgie 35:186–190

    CAS  PubMed  Google Scholar 

  57. Sparagana M, Eells RW, Stefani S, Jablokow V (1972) Osteogenic sarcoma of the skull: a rare sequela of pituitary irradition. Cancer 29:1376–1379

    Article  CAS  PubMed  Google Scholar 

  58. Sugita Y, Shigemori M, Miyagi J, Ochiai S, Lee S, Watanabe T, Abe H, Morimatsu M (1992) Radiation-induced osteosarcoma of the calvaria–case report. Neurol Med Chir (Tokyo) 32:32–35

    Article  CAS  Google Scholar 

  59. Teramoto A, Shiokawa Y, Noguchi M, Hanamura T, Mayanagi Y (1986) A case of growth hormone-producing adenoma presenting as a non-functioning tumor at recurrence. No Shinkei Geka 14:563–568

    CAS  PubMed  Google Scholar 

  60. Terry RD, Hymans VJ, Davidoff LM (1959) Combined non-metastasizing fibrosarcoma and chromophobe tumor of the pituitary. Cancer 12:791–798

    Article  CAS  PubMed  Google Scholar 

  61. Toh CH, Wong HF, Jung SM, Wong AM (2007) Radiation-induced skull base leiomyosarcoma presenting with intracerebral haemorrhage. Br J Radiol 80:e212–215

    Article  PubMed  Google Scholar 

  62. Vidal S, Syro L, Uribe H, Kovacs K, Bilbao JM, Horvath E (2000) August 1999: 49 year old woman with visual disturbances. Brain Pathol 10:169–170

    CAS  PubMed  Google Scholar 

  63. Vikhert TM, Kasumova S (1980) Radiation fibrosarcoma of the pituitary. Zh Vopr Neirokhir Im N N Burdenko 57−58

  64. Waltz TA, Brownell B (1966) Sarcoma: a possible late result of effective radiation therapy for pituitary adenoma. Report of two cases. J Neurosurg 24:901–907

    Article  CAS  PubMed  Google Scholar 

  65. Waltz TA, Brownwell B (1966) Personal communication with Russell JA. J Neurosurg 24(5):907

    Google Scholar 

  66. Wen-qing H, Shi-ju Z, Qing-sheng T, Jian-qing H, Yu-xia L, Qing-zhong X, Zi-jun L, Wen-cui Z (1982) Statistical analysis of central nervous system tumors in China. J Neurosurg 56:555–564

    Article  CAS  PubMed  Google Scholar 

  67. Wheelock MC (1963) Eosinophilic adenoma of the pituitary with sarcomatous changes. Cancer Sem 3:77–80

    Google Scholar 

  68. Willis RA (1938) Pathological study of tumors of pituitary region. Med J Aust 1:287–291

    Google Scholar 

  69. Wright AD, Hill DM, Lowy C, Fraser TR (1970) Mortality in acromegaly. Q J Med 39:1–16

    CAS  PubMed  Google Scholar 

  70. Yamamoto A, Hashimoto N, Yamashita J, Kikuchi H (1989) A case of radiation-induced intracranial fibrosarcoma with repeated episodes of intratumoral hemorrhage. No Shinkei Geka 17:193–196

    CAS  PubMed  Google Scholar 

  71. Zierhut D, Flentje M, Adolph J, Erdmann J, Raue F, Wannenmacher M (1995) External radiotherapy of pituitary adenomas. Int J Radiat Oncol Biol Phys 33:307–314

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Kantonsspital Aarau, 5001, Aarau, Switzerland

    Sven Berkmann

  2. Department of Neuropathology, University Hospital of Basel, Basel, Switzerland

    Markus Tolnay

  3. Department of Neurosurgery, University Hospital of Düsseldorf, Düsseldorf, Germany

    Daniel Hänggi

  4. Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany

    Anthony Ghaffari

  5. Division Head of Neurosurgery emeritus, Faculty of Medicine, University of Basel, Basel, Switzerland

    Otmar Gratzl

Authors
  1. Sven Berkmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Markus Tolnay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel Hänggi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anthony Ghaffari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Otmar Gratzl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sven Berkmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Berkmann, S., Tolnay, M., Hänggi, D. et al. Sarcoma of the sella after radiotherapy for pituitary adenoma. Acta Neurochir 152, 1725–1735 (2010). https://doi.org/10.1007/s00701-010-0694-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-010-0694-6

Keywords

Search

Navigation