Progression of an Invasive ACTH Pituitary Macroadenoma with Cushing’s Disease to Pituitary Carcinoma
Pituitary carcinomas are very rare tumors that in most cases produce prolactin and adrenocorticotropic hormone (ACTH). It is a challenge to diagnosis of a pituitary carcinoma before disclosed symptomatic metastasis. We report the case of a female patient with Cushing’s disease who underwent three tr...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Case Reports in Oncological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2015/810367 |
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| author | Clarissa Groberio Borba Rafael Loch Batista Nina Rosa de Castro Musolino Vanielle Carvalho Machado Ana Elisa Evangelista Alcantara Gilberto Ochman da Silva Valter Angelo Sperling Cescato Malebranche Berardo Carneiro da Cunha Neto |
| author_facet | Clarissa Groberio Borba Rafael Loch Batista Nina Rosa de Castro Musolino Vanielle Carvalho Machado Ana Elisa Evangelista Alcantara Gilberto Ochman da Silva Valter Angelo Sperling Cescato Malebranche Berardo Carneiro da Cunha Neto |
| author_sort | Clarissa Groberio Borba |
| collection | DOAJ |
| description | Pituitary carcinomas are very rare tumors that in most cases produce prolactin and adrenocorticotropic hormone (ACTH). It is a challenge to diagnosis of a pituitary carcinoma before disclosed symptomatic metastasis. We report the case of a female patient with Cushing’s disease who underwent three transsphenoidal surgeries, with pathological findings of common ACTH pituitary adenoma including Ki-67 expression <3%. She achieved hypocortisolism after the 3rd surgery although ACTH levels remained slightly elevated. The patient returned some time later with fast worsening of hypercortisolism. Magnetic resonance imaging showed clivus invasion, which led to a fourth surgery and radiation. This time, immunohistochemistry revealed strong Ki-67 (10% to 15%) and p53 expression. Liver and lumbar spine metastases were found on workup. The patient died after few months due to lung infection. Pituitary carcinomas are rare, and the transformation of an ACTH-secreting pituitary adenoma into a carcinoma is exceptional. The difficulty of defining markers for the diagnosis of carcinoma, before metastasis diagnosis, in order to change the management of the disease, is a challenge. |
| format | Article |
| id | doaj-art-890fc1af825b44138a860f71a032c38f |
| institution | Kabale University |
| issn | 2090-6706 2090-6714 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Oncological Medicine |
| spelling | doaj-art-890fc1af825b44138a860f71a032c38f2025-02-03T01:10:05ZengWileyCase Reports in Oncological Medicine2090-67062090-67142015-01-01201510.1155/2015/810367810367Progression of an Invasive ACTH Pituitary Macroadenoma with Cushing’s Disease to Pituitary CarcinomaClarissa Groberio Borba0Rafael Loch Batista1Nina Rosa de Castro Musolino2Vanielle Carvalho Machado3Ana Elisa Evangelista Alcantara4Gilberto Ochman da Silva5Valter Angelo Sperling Cescato6Malebranche Berardo Carneiro da Cunha Neto7Neuroendocrinology Unit, Functional Neurosurgery Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, BrazilNeuroendocrinology Unit, Functional Neurosurgery Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, BrazilNeuroendocrinology Unit, Functional Neurosurgery Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, BrazilNeuroendocrinology Unit, Functional Neurosurgery Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, BrazilNeuroendocrinology Unit, Functional Neurosurgery Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, BrazilPituitary Neurosurgery Unit, Functional Neurosurgery Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, BrazilPituitary Neurosurgery Unit, Functional Neurosurgery Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, BrazilNeuroendocrinology Unit, Functional Neurosurgery Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, BrazilPituitary carcinomas are very rare tumors that in most cases produce prolactin and adrenocorticotropic hormone (ACTH). It is a challenge to diagnosis of a pituitary carcinoma before disclosed symptomatic metastasis. We report the case of a female patient with Cushing’s disease who underwent three transsphenoidal surgeries, with pathological findings of common ACTH pituitary adenoma including Ki-67 expression <3%. She achieved hypocortisolism after the 3rd surgery although ACTH levels remained slightly elevated. The patient returned some time later with fast worsening of hypercortisolism. Magnetic resonance imaging showed clivus invasion, which led to a fourth surgery and radiation. This time, immunohistochemistry revealed strong Ki-67 (10% to 15%) and p53 expression. Liver and lumbar spine metastases were found on workup. The patient died after few months due to lung infection. Pituitary carcinomas are rare, and the transformation of an ACTH-secreting pituitary adenoma into a carcinoma is exceptional. The difficulty of defining markers for the diagnosis of carcinoma, before metastasis diagnosis, in order to change the management of the disease, is a challenge.http://dx.doi.org/10.1155/2015/810367 |
| spellingShingle | Clarissa Groberio Borba Rafael Loch Batista Nina Rosa de Castro Musolino Vanielle Carvalho Machado Ana Elisa Evangelista Alcantara Gilberto Ochman da Silva Valter Angelo Sperling Cescato Malebranche Berardo Carneiro da Cunha Neto Progression of an Invasive ACTH Pituitary Macroadenoma with Cushing’s Disease to Pituitary Carcinoma Case Reports in Oncological Medicine |
| title | Progression of an Invasive ACTH Pituitary Macroadenoma with Cushing’s Disease to Pituitary Carcinoma |
| title_full | Progression of an Invasive ACTH Pituitary Macroadenoma with Cushing’s Disease to Pituitary Carcinoma |
| title_fullStr | Progression of an Invasive ACTH Pituitary Macroadenoma with Cushing’s Disease to Pituitary Carcinoma |
| title_full_unstemmed | Progression of an Invasive ACTH Pituitary Macroadenoma with Cushing’s Disease to Pituitary Carcinoma |
| title_short | Progression of an Invasive ACTH Pituitary Macroadenoma with Cushing’s Disease to Pituitary Carcinoma |
| title_sort | progression of an invasive acth pituitary macroadenoma with cushing s disease to pituitary carcinoma |
| url | http://dx.doi.org/10.1155/2015/810367 |
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