Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the Literature
Background. Purely ectopic pituitary adenomas are exceedingly rare. Here we report on a patient that presented with an incidental clival mass thought to be a chordoma. Endonasal resection, tumor pathology, and endocrinology workup revealed a prolactinoma. Case Presentation. A 41-year-old male presen...
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| Format: | Article |
| Language: | English |
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Wiley
2016-01-01
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| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2016/8371697 |
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| author | Constantine L. Karras Isaac Josh Abecassis Zachary A. Abecassis Joseph G. Adel Esther N. Bit-Ivan Rakesh K. Chandra Bernard R. Bendok |
| author_facet | Constantine L. Karras Isaac Josh Abecassis Zachary A. Abecassis Joseph G. Adel Esther N. Bit-Ivan Rakesh K. Chandra Bernard R. Bendok |
| author_sort | Constantine L. Karras |
| collection | DOAJ |
| description | Background. Purely ectopic pituitary adenomas are exceedingly rare. Here we report on a patient that presented with an incidental clival mass thought to be a chordoma. Endonasal resection, tumor pathology, and endocrinology workup revealed a prolactinoma. Case Presentation. A 41-year-old male presented with an incidental clival lesion presumed to be a chordoma. On MRI it involved the entire clivus, extended laterally to the petroclival junction, and invaded the cavernous sinuses bilaterally, encasing both internal carotid arteries, without direct extension into the sella. Intraoperatively, it was clear that the tumor originated from the clivus and that the sellar dura was completely intact. Frozen-section pathology was consistent with a pituitary adenoma. Immunostaining was positive for synaptophysin and prolactin with a low Ki-67 index, suggestive of a prolactinoma. Additional immunohistochemical stains seen in chordomas (EMA, S100, and Brachyury) and other metastatic tumors were negative. A postoperative endocrine workup revealed an elevated serum prolactin of 881.3 ng/mL (normal < 20). Conclusions. In conclusion, it is crucial to maintain an extensive differential diagnosis when evaluating a patient with a clival lesion. Ectopic clival pituitary adenomas, although rare, may warrant an endocrinological workup preoperatively as the majority may respond to medical treatment. |
| format | Article |
| id | doaj-art-92f8140647fb41b5898c6634a13fc86d |
| institution | Kabale University |
| issn | 2090-6668 2090-6676 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-92f8140647fb41b5898c6634a13fc86d2025-02-03T07:25:50ZengWileyCase Reports in Neurological Medicine2090-66682090-66762016-01-01201610.1155/2016/83716978371697Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the LiteratureConstantine L. Karras0Isaac Josh Abecassis1Zachary A. Abecassis2Joseph G. Adel3Esther N. Bit-Ivan4Rakesh K. Chandra5Bernard R. Bendok6The Ohio State University College of Medicine, Columbus, OH 43212, USADepartment of Neurological Surgery, University of Washington, Seattle, WA 98122, USAFeinberg School of Medicine, Northwestern University, Chicago, IL 60611, USAFeinberg School of Medicine, Northwestern University, Chicago, IL 60611, USADepartment of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USADepartment of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USAFeinberg School of Medicine, Northwestern University, Chicago, IL 60611, USABackground. Purely ectopic pituitary adenomas are exceedingly rare. Here we report on a patient that presented with an incidental clival mass thought to be a chordoma. Endonasal resection, tumor pathology, and endocrinology workup revealed a prolactinoma. Case Presentation. A 41-year-old male presented with an incidental clival lesion presumed to be a chordoma. On MRI it involved the entire clivus, extended laterally to the petroclival junction, and invaded the cavernous sinuses bilaterally, encasing both internal carotid arteries, without direct extension into the sella. Intraoperatively, it was clear that the tumor originated from the clivus and that the sellar dura was completely intact. Frozen-section pathology was consistent with a pituitary adenoma. Immunostaining was positive for synaptophysin and prolactin with a low Ki-67 index, suggestive of a prolactinoma. Additional immunohistochemical stains seen in chordomas (EMA, S100, and Brachyury) and other metastatic tumors were negative. A postoperative endocrine workup revealed an elevated serum prolactin of 881.3 ng/mL (normal < 20). Conclusions. In conclusion, it is crucial to maintain an extensive differential diagnosis when evaluating a patient with a clival lesion. Ectopic clival pituitary adenomas, although rare, may warrant an endocrinological workup preoperatively as the majority may respond to medical treatment.http://dx.doi.org/10.1155/2016/8371697 |
| spellingShingle | Constantine L. Karras Isaac Josh Abecassis Zachary A. Abecassis Joseph G. Adel Esther N. Bit-Ivan Rakesh K. Chandra Bernard R. Bendok Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the Literature Case Reports in Neurological Medicine |
| title | Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the Literature |
| title_full | Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the Literature |
| title_fullStr | Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the Literature |
| title_full_unstemmed | Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the Literature |
| title_short | Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the Literature |
| title_sort | clival ectopic pituitary adenoma mimicking a chordoma case report and review of the literature |
| url | http://dx.doi.org/10.1155/2016/8371697 |
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