Pituitary carcinoma with malignant growth from first presentation and fulminant clinical course - Case report and review of the literature

Abstract

Context: Although pituitary adenomas are common, pituitary carcinoma is a very rare condition. Objective: We report on a 48-yr-old male presenting with pituitary carcinoma with malignant growth from the beginning and a fulminant clinical course and give an overview of the previously reported cases, paying special attention to clinical and histological parameters thatmaypredict the clinical course. Methods: We performed a MEDLINE search for previously published cases of pituitary carcinoma and analyzed the clinical, laboratory, and radiological findings. Results: Ki-67 index and the number of metastatic diseases found on postmortem examination were significantly increased in patients with no treatment response compared to those with some treatment response (P = 0.03 and P = 0.02, respectively). In contrast, time to occurrence of metastatic disease and time to death were significantly shortened in patients with no treatment response (P = 0.01 and P = 0.02, respectively). No differences were found between the two groups for gender distribution, tumor size, mitotic activity assessed as the number of mitotic figures per 10 high-power fields, and number of locations of metastatic disease. Conclusion: Frequently relapsing, invasive adenoma should raise a suspicion of a malignant disease. Clinically only the presence of metastases is a criterion of malignancy. A high Ki-67 index in the pituitary carcinoma and early manifestation of metastatic disease appear to predict rapid disease progression. Copyright © 2011 by The Endocrine Society.