Lung adenocarcinoma metastasis within a pituitary neuroendocrine tumor: a case report with review of literature
Collision tumors involving the metastasis of malignant neoplasms to pituitary neuroendocrine tumors (PitNETs) are extremely rare. We herein report a case involving a patient with lung adenocarcinoma metastasis within a PitNET who exhibited relatively rapid progression of neurological symptoms. A 75-...
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The Japan Endocrine Society
2024-03-01
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| Series: | Endocrine Journal |
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| Online Access: | https://www.jstage.jst.go.jp/article/endocrj/71/3/71_EJ23-0372/_html/-char/en |
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| author | Koji Suzuki Shigeyuki Tahara Yujiro Hattori Shinichiro Teramoto Eitaro Ishisaka Chie Inomoto Robert Yoshiyuki Osamura Akio Morita Yasuo Murai |
| author_facet | Koji Suzuki Shigeyuki Tahara Yujiro Hattori Shinichiro Teramoto Eitaro Ishisaka Chie Inomoto Robert Yoshiyuki Osamura Akio Morita Yasuo Murai |
| author_sort | Koji Suzuki |
| collection | DOAJ |
| description | Collision tumors involving the metastasis of malignant neoplasms to pituitary neuroendocrine tumors (PitNETs) are extremely rare. We herein report a case involving a patient with lung adenocarcinoma metastasis within a PitNET who exhibited relatively rapid progression of neurological symptoms. A 75-year-old man who underwent tumor resection 36 and 18 years prior to presentation for bladder and colon cancer, respectively, without recurrence presented with bitemporal hemianopsia, ptosis, and diplopia of the right eye. Subsequent magnetic resonance imaging (MRI) revealed a tumor 3.2 cm in diameter that extended from the anterior pituitary gland to the suprasellar region. Gadolinium-enhanced MRI of the tumor showed heterogeneous contrast enhancement. Considering the relatively rapid progression of neurological symptoms, semi-emergency endoscopic endonasal transsphenoidal surgery was performed. Histopathological examination revealed a group of thyroid transcription factor-1- and napsin A-positive papillary proliferating cells intermingled with α-subunit- and steroidogenic factor-1-positive PitNET cells. Thus, the patient was diagnosed with lung adenocarcinoma metastasis within a gonadotroph PitNET. Genetic testing revealed the presence of an EGFR (Ex-19del) mutation, after which chemotherapy was initiated. Additional stereotactic radiotherapy was performed for the residual tumor in the sella turcica. With continued chemotherapy, good control of both the primary and metastatic tumors was noted after 24 months after surgery. Cases of malignant neoplasm metastasis within a PitNET are difficult to diagnose. In the case of a sella turcica tumor with relatively rapid progression of neurological symptoms, early surgical intervention is recommended given the possibility of a highly proliferative tumor and the need to obtain pathologic specimens. |
| format | Article |
| id | doaj-art-b1370751dc6945fdbbd0dbbf789ca8ec |
| institution | Kabale University |
| issn | 1348-4540 |
| language | English |
| publishDate | 2024-03-01 |
| publisher | The Japan Endocrine Society |
| record_format | Article |
| series | Endocrine Journal |
| spelling | doaj-art-b1370751dc6945fdbbd0dbbf789ca8ec2025-01-22T06:35:05ZengThe Japan Endocrine SocietyEndocrine Journal1348-45402024-03-0171329530310.1507/endocrj.EJ23-0372endocrjLung adenocarcinoma metastasis within a pituitary neuroendocrine tumor: a case report with review of literatureKoji Suzuki0Shigeyuki Tahara1Yujiro Hattori2Shinichiro Teramoto3Eitaro Ishisaka4Chie Inomoto5Robert Yoshiyuki Osamura6Akio Morita7Yasuo Murai8Department of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, JapanDepartment of Neurological Surgery, Nippon Medical School Musashikosugi Hospital, Kanagawa 211-8233, JapanDepartment of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, JapanDepartment of Neurosurgery, Juntendo University School of Medicine, Tokyo 113-8431, JapanDepartment of Neurological Surgery, Nippon Medical School Musashikosugi Hospital, Kanagawa 211-8233, JapanDepartment of Pathology, Tokai University School of Medicine, Kanagawa 259-1143, JapanDepartment of Pathology, Nippon Koukan Hospital, Kanagawa 210-0852, JapanDepartment of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, JapanDepartment of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, JapanCollision tumors involving the metastasis of malignant neoplasms to pituitary neuroendocrine tumors (PitNETs) are extremely rare. We herein report a case involving a patient with lung adenocarcinoma metastasis within a PitNET who exhibited relatively rapid progression of neurological symptoms. A 75-year-old man who underwent tumor resection 36 and 18 years prior to presentation for bladder and colon cancer, respectively, without recurrence presented with bitemporal hemianopsia, ptosis, and diplopia of the right eye. Subsequent magnetic resonance imaging (MRI) revealed a tumor 3.2 cm in diameter that extended from the anterior pituitary gland to the suprasellar region. Gadolinium-enhanced MRI of the tumor showed heterogeneous contrast enhancement. Considering the relatively rapid progression of neurological symptoms, semi-emergency endoscopic endonasal transsphenoidal surgery was performed. Histopathological examination revealed a group of thyroid transcription factor-1- and napsin A-positive papillary proliferating cells intermingled with α-subunit- and steroidogenic factor-1-positive PitNET cells. Thus, the patient was diagnosed with lung adenocarcinoma metastasis within a gonadotroph PitNET. Genetic testing revealed the presence of an EGFR (Ex-19del) mutation, after which chemotherapy was initiated. Additional stereotactic radiotherapy was performed for the residual tumor in the sella turcica. With continued chemotherapy, good control of both the primary and metastatic tumors was noted after 24 months after surgery. Cases of malignant neoplasm metastasis within a PitNET are difficult to diagnose. In the case of a sella turcica tumor with relatively rapid progression of neurological symptoms, early surgical intervention is recommended given the possibility of a highly proliferative tumor and the need to obtain pathologic specimens.https://www.jstage.jst.go.jp/article/endocrj/71/3/71_EJ23-0372/_html/-char/encollision tumormetastasispituitary neuroendocrine tumorlung adenocarcinomamolecular-targeted therapy |
| spellingShingle | Koji Suzuki Shigeyuki Tahara Yujiro Hattori Shinichiro Teramoto Eitaro Ishisaka Chie Inomoto Robert Yoshiyuki Osamura Akio Morita Yasuo Murai Lung adenocarcinoma metastasis within a pituitary neuroendocrine tumor: a case report with review of literature Endocrine Journal collision tumor metastasis pituitary neuroendocrine tumor lung adenocarcinoma molecular-targeted therapy |
| title | Lung adenocarcinoma metastasis within a pituitary neuroendocrine tumor: a case report with review of literature |
| title_full | Lung adenocarcinoma metastasis within a pituitary neuroendocrine tumor: a case report with review of literature |
| title_fullStr | Lung adenocarcinoma metastasis within a pituitary neuroendocrine tumor: a case report with review of literature |
| title_full_unstemmed | Lung adenocarcinoma metastasis within a pituitary neuroendocrine tumor: a case report with review of literature |
| title_short | Lung adenocarcinoma metastasis within a pituitary neuroendocrine tumor: a case report with review of literature |
| title_sort | lung adenocarcinoma metastasis within a pituitary neuroendocrine tumor a case report with review of literature |
| topic | collision tumor metastasis pituitary neuroendocrine tumor lung adenocarcinoma molecular-targeted therapy |
| url | https://www.jstage.jst.go.jp/article/endocrj/71/3/71_EJ23-0372/_html/-char/en |
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