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Intracranial dissemination of pituitary adenoma. Case report and review of the literature

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Abstract

Leptomeningeal dissemination of pituitary adenoma is a very rare occurrence. The present report describes the case of a 28 year old man with a nonfunctioning pituitary adenoma which was operated on and irradiated. Eight years later, the patient developed Cushing's syndrome and multiple leptomeningeal masses were revealed by brain CT and MNR. The diagnosis was ACTH-cell adenoma, without malignant histological signs.

The growth fraction of the tumor, detected by means of the immunohistochemical demonstration of proliferating cell nuclear antigen (PCNA), was 5.45% of cells; this figure is higher than that reported for non-recurrent pituitary adenomas.

From a review of the reported cases, the possibility of predicting late malignant behaviour is discussed. The microscopic aspect has no prognostic value, since metastasizing cases are not overtly malignant in a histological or cytological sense. The application of methods aimed at detecting the growth fraction of the tumor may prove useful in the early identification of aggressive pituitary tumors.

Sommario

La disseminazione leptomeningea di un adenoma ipofisario rappresenta un'evenienza estremamente rara. In questo lavoro si presenta il caso di un adenoma ipofisario non secernente, sviluppatosi in un uomo di 28 anni, sottoposto a trattamento chirurgico e radioterapico. Otto anni più tardi il paziente manifestava una sindrome di Cushing; l'indagine neuroradiologica mediante TC e RMN evidenziava la presenza di masse multiple in sede leptomeningea. Veniva posta diagnosi di adenoma a cellule ACTH-positive, privo di segni di malignità istologica.

La frazione di crescita della neoplasia, determinata mediante dimostrazione immunoistochimica dell'antigene nucleare di proliferazione cellulare (PCNA), corrispondeva al 5,45% delle cellule; tale valore risulta più elevato di quello riferito in letteratura per gli adenomi ipofisari non recidivanti.

Viene discussa, in base alla revisione dei casi finora descritti, la possibilità di prevedere l'acquisizione tardiva di un comportamento maligno da parte di un adenoma ipofisario. L'aspetto microscopico non possiede valore prognostico, poiché adenomi metastatizzanti non hanno aspetto istologico francamente maligno. La determinazione della frazione di crescita tumorale può servire a questo scopo.

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Authors and Affiliations

  1. Clinica Neurologica II, Università di Torino, Via Cherasco 15, 10126, Torino

    Giordana M. T. & Cavalla P.

  2. Istituto Nazionale Neurologico “C. Besta”, Via Cherasco 15, 10126, Milano

    Allegranza A. & Pollo B.

Authors
  1. Giordana M. T.
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  2. Cavalla P.
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  3. Allegranza A.
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  4. Pollo B.
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Additional information

This study was supported by P.F.A.C.R.O., C.N.R., Rome

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Giordana, M.T., Cavalla, P., Allegranza, A. et al. Intracranial dissemination of pituitary adenoma. Case report and review of the literature. Ital J Neuro Sci 15, 195–200 (1994). https://doi.org/10.1007/BF02339323

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  • DOI: https://doi.org/10.1007/BF02339323

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