A silent corticotroph pituitary carcinoma: lessons from an exceptional case

Nowadays, neither imaging nor pathology evaluation can accurately predict the aggressiveness or treatment resistance of pituitary tumors at diagnosis. However, histological examination can provide useful information that might alert clinicians about the nature of pituitary tumors. Here, we describe...

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Autores: Remón-Ruiz, Pablo, Venegas-Moreno, Eva, Dios-Fuentes, Elena, Canelo Moreno, Juan Manuel, Fernández Peña, Ignacio, Alonso García, Miriam, Soto Moreno, Alfonso Manuel
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Universidad de Sevilla (US)
Repositorio:idUS. Depósito de Investigación de la Universidad de Sevilla
OAI Identifier:oai:idus.us.es:11441/137243
Acceso en línea:https://hdl.handle.net/11441/137243
https://doi.org/10.3389/fendo.2021.784889
Access Level:acceso abierto
Palabra clave:Pituitary tumor
Silent corticothoph tumor
Pituitary carcinoma
Radiotherapy
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spelling A silent corticotroph pituitary carcinoma: lessons from an exceptional caseRemón-Ruiz, PabloVenegas-Moreno, EvaDios-Fuentes, ElenaCanelo Moreno, Juan ManuelFernández Peña, IgnacioAlonso García, MiriamSoto Moreno, Alfonso ManuelPituitary tumorSilent corticothoph tumorPituitary carcinomaRadiotherapyNowadays, neither imaging nor pathology evaluation can accurately predict the aggressiveness or treatment resistance of pituitary tumors at diagnosis. However, histological examination can provide useful information that might alert clinicians about the nature of pituitary tumors. Here, we describe our experience with a silent corticothoph tumor with unusual pathology, aggressive local invasion and metastatic dissemination during follow-up. We present a 61-year-old man with third cranial nerve palsy at presentation due to invasive pituitary tumor. Subtotal surgical approach was performed with a diagnosis of silent corticotroph tumor but with unusual histological features (nuclear atypia, frequent multinucleation and mitotic figures, and Ki-67 labeling index up to 70%). After a rapid regrowth, a second surgical intervention achieved successful debulking. Temozolomide treatment followed by stereotactic fractionated radiotherapy associated with temozolomide successfully managed the primary tumor. However, sacral metástasis showed up 6 months after radiotherapy treatment. Due to aggressive distant behavior, a carboplatine-etoposide scheme was decided but the patient died of urinary sepsis 31 months after the first symptoms. Our case report shows how the presentation of a pituitary tumor with aggressive features should raise a suspicion of malignancy and theneed of follow up by multidisciplinary team with experience in its management. Metastases may occur even if the primary tumor is well controlled.Frontiers Research FoundationMedicina2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/11441/137243https://doi.org/10.3389/fendo.2021.784889reponame:idUS. Depósito de Investigación de la Universidad de Sevillainstname:Universidad de Sevilla (US)InglésFrontiers in Endocrinology, 12, 1-9.https://www.frontiersin.org/articles/10.3389/fendo.2021.784889/fullinfo:eu-repo/semantics/openAccessoai:idus.us.es:11441/1372432026-06-17T12:51:07Z
dc.title.none.fl_str_mv A silent corticotroph pituitary carcinoma: lessons from an exceptional case
title A silent corticotroph pituitary carcinoma: lessons from an exceptional case
spellingShingle A silent corticotroph pituitary carcinoma: lessons from an exceptional case
Remón-Ruiz, Pablo
Pituitary tumor
Silent corticothoph tumor
Pituitary carcinoma
Radiotherapy
title_short A silent corticotroph pituitary carcinoma: lessons from an exceptional case
title_full A silent corticotroph pituitary carcinoma: lessons from an exceptional case
title_fullStr A silent corticotroph pituitary carcinoma: lessons from an exceptional case
title_full_unstemmed A silent corticotroph pituitary carcinoma: lessons from an exceptional case
title_sort A silent corticotroph pituitary carcinoma: lessons from an exceptional case
dc.creator.none.fl_str_mv Remón-Ruiz, Pablo
Venegas-Moreno, Eva
Dios-Fuentes, Elena
Canelo Moreno, Juan Manuel
Fernández Peña, Ignacio
Alonso García, Miriam
Soto Moreno, Alfonso Manuel
author Remón-Ruiz, Pablo
author_facet Remón-Ruiz, Pablo
Venegas-Moreno, Eva
Dios-Fuentes, Elena
Canelo Moreno, Juan Manuel
Fernández Peña, Ignacio
Alonso García, Miriam
Soto Moreno, Alfonso Manuel
author_role author
author2 Venegas-Moreno, Eva
Dios-Fuentes, Elena
Canelo Moreno, Juan Manuel
Fernández Peña, Ignacio
Alonso García, Miriam
Soto Moreno, Alfonso Manuel
author2_role author
author
author
author
author
author
dc.contributor.none.fl_str_mv Medicina
dc.subject.none.fl_str_mv Pituitary tumor
Silent corticothoph tumor
Pituitary carcinoma
Radiotherapy
topic Pituitary tumor
Silent corticothoph tumor
Pituitary carcinoma
Radiotherapy
description Nowadays, neither imaging nor pathology evaluation can accurately predict the aggressiveness or treatment resistance of pituitary tumors at diagnosis. However, histological examination can provide useful information that might alert clinicians about the nature of pituitary tumors. Here, we describe our experience with a silent corticothoph tumor with unusual pathology, aggressive local invasion and metastatic dissemination during follow-up. We present a 61-year-old man with third cranial nerve palsy at presentation due to invasive pituitary tumor. Subtotal surgical approach was performed with a diagnosis of silent corticotroph tumor but with unusual histological features (nuclear atypia, frequent multinucleation and mitotic figures, and Ki-67 labeling index up to 70%). After a rapid regrowth, a second surgical intervention achieved successful debulking. Temozolomide treatment followed by stereotactic fractionated radiotherapy associated with temozolomide successfully managed the primary tumor. However, sacral metástasis showed up 6 months after radiotherapy treatment. Due to aggressive distant behavior, a carboplatine-etoposide scheme was decided but the patient died of urinary sepsis 31 months after the first symptoms. Our case report shows how the presentation of a pituitary tumor with aggressive features should raise a suspicion of malignancy and theneed of follow up by multidisciplinary team with experience in its management. Metastases may occur even if the primary tumor is well controlled.
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11441/137243
https://doi.org/10.3389/fendo.2021.784889
url https://hdl.handle.net/11441/137243
https://doi.org/10.3389/fendo.2021.784889
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Frontiers in Endocrinology, 12, 1-9.
https://www.frontiersin.org/articles/10.3389/fendo.2021.784889/full
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Frontiers Research Foundation
publisher.none.fl_str_mv Frontiers Research Foundation
dc.source.none.fl_str_mv reponame:idUS. Depósito de Investigación de la Universidad de Sevilla
instname:Universidad de Sevilla (US)
instname_str Universidad de Sevilla (US)
reponame_str idUS. Depósito de Investigación de la Universidad de Sevilla
collection idUS. Depósito de Investigación de la Universidad de Sevilla
repository.name.fl_str_mv
repository.mail.fl_str_mv
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