Corticotroph pituitary carcinoma: Case report and literature review
Pituitary carcinomas, currently defined as primary adenohypophyseal neoplasms with evidence of either brain invasion or metastatic spread, are exceptionally rare. A case of corticotroph pituitary carcinoma is reported. A 17-yr-old female first presented with an invasive and clinically nonfunctioning pituitary macroadenoma. The primary pituitary lesion lacked atypical histological features and retrospective immunohistochemical studies confirmed its corticotrophic nature. Repeated episodes of local recurrence followed together with the acquisition of severe Cushing’s disease. Local disease control was not obtained despite repeated surgical decompression and courses of radiation therapy. Systemic dissemination with multiple bone metastases became manifest eleven years after the first presentation. Atypical histological features and Crooke’s hyaline change were evident in both the recurrent and metastatic disease. She remains alive at last follow-up with severe complications relating to persisting sellar and metastatic disease and ongoing endocrine dysfunction. A further 32 cases of pituitary corticotroph carcinoma reported in English are reviewed to highlight the clinicopathological features of this rare form of pituitary neoplasm. Difficulties associated with the diagnosis and management of pituitary carcinoma are also discussed.
Key WordsPituitary carcinoma corticotroph metastases Cushing’s disease Crooke’s hyaline change
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- 1.Solcia E., Kloppel G, Sobin LH. W.H.O. 2000 Histologic Typing of Endocrine Tumors. 2nd ed. New York: Springer-Verlag, 2000.Google Scholar
- 12.Kouhara H, Tatekawa T, Koga M, et al. Intracranial and intraspinal dissemination of an ACTH-secreting pituitary tumor. Endocrinol Japan 39:177–184, 1992.Google Scholar
- 13.Gabrilove JL, Anderson PJ, Halmi NS. Pituitary pro-opiomelanocortin-cell carcinoma occurring in conjunction with a glioblastoma in a patient with Cushing’s disease and subsequent Nelson’s syndrome. Clin Endocrinol 25:117–126, 1986.Google Scholar
- 17.Gaffey T, Scheithauer BW, Lloyd RV, et al. Corticotroph carcinoma of the pituitary: A clinicopathological study. J Neurosurg, in press.Google Scholar
- 23.Scholz DA, Gastineau CF, Harrison EG. Cushing’s syndrome with malignant chromophobe tumor of the pituitary and extracranial metastasis: report of a case. Mayo Proc 37:31–42, 1962.Google Scholar
- 24.Queiroz L de S, Facure NO, Facure JJ, Modesto NP, Lopes de Faria J. Pituitary carcinoma with liver metastases and Cushing syndrome. report of a case. Arch Pathol 99:32–35, 1975.Google Scholar
- 29.Della Casa S, Corsello SM, Satta MA, et al. Intracranial and spinal dissemination of an ACTH secreting pituitary neoplasia. Case report and review of the literature. Ann Endocrinol (Paris) 58:503–509, 1997.Google Scholar
- 35.Robert F, Hardy J. Human Corticotroph Cell Adenomas. Semin Diag Path 3:34–41, 1986.Google Scholar
- 36.Grua JR, Nelson DH. ACTH-Producing pituitary tumors. Endocr Metab Clin Nth Amer 20:319–362, 1991.Google Scholar
- 45.Horvath E, Kovacs K, Josse R. Pituitary corticotroph cell adenoma with marked abundance of microfilaments. Ultrastruct Path 5:249–255, 1983.Google Scholar