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首页> 外文期刊>Diagnostic pathology >Case report: ACTH-secreting pituitary carcinoma metastatic to the liver in a patient with a history of atypical pituitary adenoma and Cushing’s disease
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Case report: ACTH-secreting pituitary carcinoma metastatic to the liver in a patient with a history of atypical pituitary adenoma and Cushing’s disease

机译：病例报告：患有非典型垂体腺瘤和库欣病的患者中，分泌ACTH的垂体垂体癌转移至肝脏

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BackgroundPituitary carcinoma is a rare entity requiring the presence of metastasis to confirm its malignant potential. We report a case of pituitary carcinoma and discuss the diagnosis and management of this lesion in relation to the existing literature. Case presentationThe patient is a 51-year-old woman with Cushing’s disease and intact adrenal glands who was diagnosed with metastatic pituitary carcinoma to the liver, 29?months after initial resection of an ACTH-secreting primary atypical pituitary adenoma (APA). Prior to detection of this metastasis the patient underwent repeat resection and radiotherapy for residual cavernous sinus disease. The metastatic lesion was detected by interval surveillance of serum ACTH and 24-hour urine cortisol, which despite stable pituitary MRI, were significantly elevated. These abnormalities prompted a PET scan that demonstrated hypermetabolic liver parenchyma, which was suspicious for metastasis on abdominal MRI. An ultrasound-guided liver biopsy demonstrated nests of moderately-differentiated cells with intermediate-sized, monotonous nuclei, distinct nucleoli, and abundant basophilic cytoplasm, confirmed by immunohistochemistry to represent metastatic pituitary carcinoma. The liver lesion was subsequently successfully removed by wedge resection. One year later, the patient’s residual cavernous sinus disease grew markedly, and she was placed on dual-agent chemotherapy consisting of oral temozolomide and capecitabine, with stabilization of her intracranial disease to present, although liver metastases recurred. ConclusionsPituitary carcinoma is a rare entity impossible to recognize as a primary tumor because its diagnosis by definition requires the presence of metastasis. Maintaining awareness of the entity and its precursor lesion APA is essential for its accurate pathologic diagnosis and appropriate management.
机译：背景垂体癌是一种罕见的实体，需要转移以确认其恶性潜能。我们报告一例垂体癌，并与现有文献讨论该病变的诊断和治疗。病例介绍该患者是一名51岁的库欣病和完整的肾上腺女性，在初次切除分泌ACTH的原发性非典型垂体腺瘤（APA）切除29个月后，被诊断为肝转移性垂体癌。在检测到这种转移之前，应对残留的海绵窦疾病进行重复切除和放疗。通过定期监测血清ACTH和24小时尿皮质醇可检测到转移性病变，尽管垂体MRI稳定，但仍显着升高。这些异常促使PET扫描显示出代谢亢进的肝实质，这对腹部MRI怀疑有转移。超声引导下的肝活检表明，中等分化细胞的巢具有中等大小，单调的核，独特的核仁和丰富的嗜碱性细胞质，通过免疫组织化学证实可代表转移性垂体癌。随后通过楔形切除术成功清除了肝脏病变。一年后，患者残留的海绵窦疾病明显增长，她接受了口服替莫唑胺和卡培他滨组成的双药化疗，尽管复发了肝转移，但仍能稳定颅内疾病。结论垂体癌是一种罕见的无法识别为原发性肿瘤的实体，因为根据定义其诊断需要转移。保持对实体及其前体病变APA的认识对于其准确的病理诊断和适当的管理至关重要。

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