Pituitary stalk metastasis from breast cancer treated with systemic chemotherapy

We describe a 61-year-old woman with diabetes insipidus caused by a pituitary stalk metastasis from breast cancer. She had a medical history of breast conservation therapy for early breast cancer 5 years previously. Pituitary, lung, liver, bone and neck lymphnode metastases was revealed at the same time. She received systemic chemotherapy consisting of docetaxel and cisplatin. After chemotherapy MRI finding in pituitary gland was improved, lung and liver metastases also improved, however, symptoms of diabetes insipidus did not improve. She is alive, receiving endocrine treatment for 2 years, since onset of diabetes insipidus.     

Panhypopituitarism in a patient with breast cancer

BACKGROUND: Malaise and fatigue are common symptoms of advanced malignant disease. Nevertheless, a specific cause--requiring specified treatment--for this symptom should be ruled out. We report on a patient with a complex endocrine dysfunction that developed due to a tiny metastasis of a breast carcinoma in the pituitary stalk. CASE REPORT: A 46- year-old woman presented with general ill feeling 3 years after operation for a breast carcinoma. She was diagnosed to have hepatic and peritoneal metastases and malignant pleural effusion. For the application of chemotherapy, an i.v.-port system in the right brachiocephalic vein was inserted. In the postoperative period, an emergency situation developed due to demasked cortisol deficiency and hypernatremia. Careful laboratory investigations revealed hypofunction of the anterior lobe of the pituitary gland and diabetes insipidus centralis. By MRI imaging of the parasellar region, a 4 x 5 mm metastatic lesion in the pituitary stalk was found--notable only in knowledge of the clinical diagnosis. The patient's condition and quality of life improved markedly with hormone replacement therapy. CONCLUSION: Metastatic cancer may present as endocrine disease, either by release of hormone-like substances or by tumorous destruction of endocrine structures. Metastases of solid tumors to the pituitary gland are often asymptomatic or present with diabetes insipidus. The presentation with a hypofunction of the anterior and posterior lobe of the pituitary gland is a rare event. It is recommended to consider endocrine dysfunction as potential cause of 'malaise' in a cancer patient.     

Diabetes insipidus caused by isolated intracranial metatstases in patient with breast cancer

Summary We present a case of late recurrence of breast cancer manifested with diabetes insipidus caused by isolated intracranial metastases. A 57-year-old postmenopausal woman was diagnosed with breast cancer and underwent radical mastectomy, without any adjuvant therapy. Seventeen years later, she presented with polyuria, polydipsia, weight loss, weakness, diffuse bone pain, hoarseness and mild dyspnoea. Cranial CT revealed several dural masses in the frontal, parietal and occipital lobes and along the falx cerebri. The diagnosis of central diabetes insipidus without impairment of anterior pituitary function was based on the clinical symptoms, laboratory tests and imaging findings. The patient was successfully treated with desmopressin acetate and letrozole, and remained alive and ambulating 22 months after initial presentation with diabetes insipidus.     

A case of breast cancer metastatic to the pituitary gland

A case of breast cancer that developed pituitary metastasis 22 years after mastectomy is reported. The pituitary metastasis was associated with hypopituitarism, impairment of the visual field and later diabetes insipidus. The serum levels of CA15-3 and NCC-ST-439, tumor markers of breast cancer, were increased, and CA15-3 (DF3) and NCC-ST-439 were demonstrated in the resected pituitary metastatic lesion immunohistochemically.     

Panhypopituitarism due to Metastases to the Hypothalamus and the Pituitary Resulting From Primary Breast Cancer: A Case Report and Review of the Literature

Pituitary metastasis occurs rarely in cancer patients and often remains undiagnosed. However, early detection and appropriate treatment can improve the patient's quality of life and possibly prolong survival. Herein, we describe the case of a 52-year-old woman with panhypopituitarism caused by metastases to the hypothalamus and pituitary from primary breast cancer. She had a 5-year history of breast cancer with metastases to the bones 1.5 years after initial diagnosis and mastectomy. She presented with severe headaches, generalized fatigue, dizziness, hypotension, difficulties with balance and coordination, polyuria, and polydipsia. Laboratory work-up revealed panhypopituitarism (central diabetes insipidus; hypothyroidism; and low prolactin, gonadotrophin, and adrenocorticotropic hormone levels), and magnetic resonance imaging confirmed the pituitary and hypothalamic involvement. She received hormone replacement therapy, radiation therapy of the sella turcica and suprasellar lesion, and chemotherapy, with significant improvement of her clinical status, but she died 15 months later.     

Nephrogenic diabetes insipidus. An unusual presentation of recurrent rectal cancer

The occurrence of diabetes insipidus (DI) in patients with systemic cancer is caused usually by tumor metastasis to the hypothalamus or posterior pituitary. A 43-year-old man with DI 8 months after radical surgery for a poorly differentiated adenocarcinoma of the distal rectum is reported. A therapeutic trial of intranasal desmopressin acetate did not correct the hyposthenuria, thus localizing the defect to the kidneys. A large tumor recurrence in the pelvis caused bilateral hydroureteronephrosis, resulting in nephrogenic DI. This report shows that not all cases of DI in cancer patients are of central origin.     

Prostate Cancer Metastasis to the Pituitary Gland Manifesting as Corticosteroid Withdrawal,and the Impact of the Switch from Prednisone to Dexamethasone on Survival Time

Despite improvements in the diagnosis and treatment of cancers, the incidence of pituitary metastasis has increased. Prostate cancer metastasis to the pituitary, however, is rare, and these tumors usually grow rapidly. They are also more likely to be located in the posterior pituitary, and the presenting symptoms are often nonspecific, which makes early diagnosis challenging. The management of this condition is usually multidisciplinary, and requires careful assessment and decision making. We present a case of a patient who developed prostate cancer metastasis to the pituitary. In this report, we show that patients with prostate cancer on corticosteroid therapy who develop withdrawal symptoms or other endocrine symptoms should be assessed for pituitary and other brain metastasis. This case report also discusses the impact of switching from prednisone and abiraterone to dexamethasone and abiraterone. Our report shows that patients on abiraterone and prednisone whose PSA has increased, but who have no radiologic progression, may have their PSA controlled and thereby improved survival time when they are switched to abiraterone and dexamethasone.     

Hypothalamo-hypophyseal and gastric metastasis of a breast neoplasm. Clinical case and a review of the literature]

The authors report the case of a young woman with advanced breast cancer who developed diabetes insipidus due to pituitary involvement and also gastric metastases. This patient had a normal brain CT scan. Gastric metastases were diagnosed when she was operated for a perforated gastric ulcer. Although very rare, and even if the brain CT scan is normal, pituitary metastases should be diagnosed in the presence of suggestive clinical symptoms. Abdominal pain also warrants investigation in these patients in an early attempt to document any possible gastric metastases.     

Metástasis hipotálamo-hipofisaria en paciente con cáncer de mama

Pan-hypopituitarism is an unusual initial clinical presentation of metastatic stage breast cancer. Breast and lung cancers are the most frequent sites in women and in men associated with parasellar metastasis and hypothalamic invasion. Reported incidence of pituitary metastases is <5%. Treatment is, essentially, palliative and depends on the symptoms, the extent of the systemic disease, and the performance status of the patient. Prognosis is poor not only because the location of the metastasis but because of the aggressiveness of the primary neoplasia. We report, here, the case of a 59 year-old woman with a medical history that included breast cancer in 1989 and colon cancer in 1998. She was admitted to our hospital with general malaise and hypoglycaemia. Endocrine testing revealed pan-hypopituitarism, and magnetic resonance imaging showed thickening of the pituitary stalk.     

肺癌脑膜转移11例临床分析

目的:探讨肺癌合并脑膜转移的临床表现、诊断、治疗和预后。方法:回顾分析11例肺癌脑膜转移患者的临床资料。结果:11例腺癌患者均有头痛、呕吐等神经系统症状,影像学表现为脑膜强化、脑室扩张及脑转移。9例患者颅内压升高,11例患者脑脊液均发现肿瘤细胞。9例患者接受了综合治疗,包括全身化疗、靶向治疗、鞘内化疗、脑室腹腔分流术、全脑放疗。中位生存期3个月。结论:脑膜转移是晚期肺癌并发症之一,根据临床表现、影像学及脑脊液检查可明确诊断。给予鞘内化疗、靶向治疗等综合治疗可减轻症状、延长生存。     

哑铃形垂体腺瘤经蝶显微手术技巧

背景与目的：哑铃形垂体腺瘤的手术治疗入路一直存在争议，本文探讨经蝶显微手术哑铃形垂体腺瘤的手术技巧和手术疗效。方法：回顾性分析经蝶显微手术治疗45例哑铃形垂体腺瘤的临床资料、手术疗效、术后并发症及随访结果。结果：全切除35例，次全切除7例，大部分切除3例。术后所有患者的临床症状得以改善，16／19患者的内分泌功能恢复正常。术后1周视力、视野恢复率分别为90．6％和81．3％。术后并发症有一过性尿崩17例、短暂性脑脊液鼻漏3例等，无持续性尿崩，无手术死亡。结论：除质地硬的哑铃形垂体腺瘤外，绝大多数哑铃形垂体腺瘤经蝶手术是安全、有效的。     

Clinicopathologic review of 88 cases of carcinoma metastatic to the putuitary gland.

Clinical and pathologic features of 88 cases of carcinoma metastatic to the pituitary gland were reviewed.In 61 (69.3%), metastases were localized either in the posterior lobe alone or in the posterior and anterior lobes together; only 12 (13.6%) involved the anterior lobe alone. Diabetes insipidus was present in 6 patients (6.8%), one of whom also had clinical panhypopituitarism due to metastatic tumor and necrosis in the anterior pituitary lobe. Breast and lung were the most frequent primary sites in women and men, respectively. Sixty-four (72.7%) of these glands were grossly normal at necropsy. Metastases to the pituitary gland occur more frequently in the posterior lobe than in the anterior lobe, and my ve reflected clinically by diabetes insipidus in patients with diseminated carcinoma. Clinical panhypopituitarism is a rare accompaniment of anterior lobe involvement.     

Radiation therapy for diabetes insipidus caused by Langerhans cell histiocytosis.

Hypothalamic-pituitary radiation therapy has been the standard treatment for the diabetes insipidus of Langerhans cell histiocytosis. The goal of this study was to assess the role of radiation therapy in Langerhans cell histiocytosis-associated diabetes insipidus and to compare the results with nonirradiated controls. Forty-seven patients with pathologically confirmed Langerhans cell histiocytosis were diagnosed with diabetes insipidus between 1950 and 1989 and were treated at the Mayo Clinic. These patients were divided into two groups on the basis of treatment for the diabetes insipidus: The first group (radiation group) included 30 patients (28 of whom were evaluable for response) who received hypothalamic-pituitary radiation therapy, and the second group (control group) included 17 patients who did not. A partial response to treatment was defined as a reduction in vasopressin dosage or improvement in computed tomography (CT) or magnetic resonance imaging (MRI). A complete response was defined as no further need for vasopressin therapy or normalization of CT or MRI. End points analyzed included treatment response, patient characteristics, morbidity, dose-response relationship, and survival. Patient characteristics of the two groups were similar except for age and lung involvement, both of which were significantly less in the radiation group. Thirty-six percent of patients (10 of 28) in the radiation group responded to hypothalamic-pituitary radiation therapy (22% complete response and 14% partial response), whereas none in the control group responded. Five of the six complete responders were irradiated within 14 days of the diagnosis of diabetes insipidus. The mean dose used in the responding and nonresponding patients was 11.2 and 10 Gy, respectively. Three of five patients (60%) treated with more than 15 Gy responded compared to seven of 23 (30%) treated with less than 15 Gy. Eight of the 10 responders (80%), compared to 16 of 35 nonresponders (46%), were female. Only one in 20 patients with concomitant lung histiocytosis responded. Complications of therapy may include insufficiency in other hypothalamic-pituitary axes in the treated patients. Actuarial survivals at 5, 10, 20, and 40 years for the entire group were 80%, 78%, 75%, and 65%, respectively, with a median follow-up in living patients of 14.7 years.     

肺癌胰腺转移的临床特点及预后分析

背景与目的 由于缺乏特异的临床症状,70%的肺癌患者确诊时为局部晚期或晚期,多数患者伴有实性器官转移,不同部位转移患者的临床表现及预后不同.随着诊断技术的发展,肺癌伴胰腺转移似有逐渐增多趋势.本研究针对肺癌胰腺转移的临床特点、诊治、预后及生存情况进行统计分析,探讨肺癌胰腺转移的相关预后因素.方法 回顾性分析1996年7月-2017年6月于北京肿瘤医院胸部肿瘤内一科就诊的35例经病理确诊的肺癌并胰腺转移或在治疗过程中出现胰腺转移的患者,其中33例有完整随访资料.结果 35例患者中,小细胞肺癌28例(80%),腺癌3例(8.6%),鳞癌4例(11.4%).初治时即存在胰腺转移者21例(60%),14例治疗过程中出现胰腺转移(40%).在胰腺转移灶中,胰头转移者15例(42.9%),胰腺体尾部转移者20例(57.1%),单发转移23例(65.7%),多发转移12例(34.3%).肺癌胰腺转移患者多无明显临床症状,本组病例中,仅4例患者在病程中出现胰腺炎症状.病理类型是影响肺癌胰腺转移患者生存的独立预后因素.结论 部分晚期肺癌患者可以出现胰腺转移,多见于小细胞肺癌.肺癌患者出现胰腺转移,治疗原则以全身化疗为主的综合治疗.病理类型是影响肺癌胰腺转移患者生存的独立预后因素.     

Panhypopituitarism as first manifestation of a lung cancer

Pituitary metastases of solid tumours are infrequent, specially as a first manifestation. When they happen, they are usually due to breast or lung cancer and are asymptomatic or produce diabetes insipidus. It is very strange that they produce hormonal deficiency. We present a case report of a bronchogenic adenocarcinoma in a 65-year-old man which began with panhypopituitarism, diabetes insipidus and visual alterations. Magnetic resonance imaging revealed a large sellar mass, with clivus infiltration and invading the right cavernous sinus. The biopsy result was adenocarcinoma metastases from lung cancer.     

Gastric cancer metastatic to the pituitary gland: a case report

Neoplasms from almost every tissue have been reported to metastasize to the pituitary. Gastric carcinoma is a rare cause of metastases in pituitary gland. Gastric carcinoma will be the primary tumor in less than 2% of patients with pituitary gland metastases. We report the case of a 60-years old white man with liver metastasis from gastric cancer with fair presentation symptoms of pituitary gland metastasis. Basal endocrinological work-up showed corticotroph, gonadotroph, somatotroph and thyrotroph cell insufficiency; serum PRL was elevated and no deficit of the ADH level was observed. Despite the hormonal deficits the patient did not report any specific symptom. After diagnosis the patient began thyroid and adrenal-replacement therapy and was referred to Radiotherapy Unit for treatment on the sellar and pituitary gland region.     

Diabetes insípida central como primera manifestación clínica de un carcinoma colorrectal metastásico

Metastases of systemic tumours in the hypothalamus-pituitary region are reported to be around 1% to 4% of all intra-cranial metastases. Most of them are diagnosed when the primary tumour is operated-upon, or when widespread metastases occur. The metastasic infiltration of this region is usually asymptomatic and rarely recognised ante-mortem. The metastases rarely clinically manifest, but diabetes insipidus is the most frequent. Autopsy studies have shown breast and lung cancer are the mostfrequent cause of the metastases in this region. We present a clinical case of a patient presenting diabetes insipidus as the first manifestation of a metastasic colorectal cancer.     

Multidisciplinary strategy for lung cancer patients with bone metastasis

The fall of QOL by bone metastasis poses a problem with the increase in lung cancer. The examples of long-term survival of lung cancer are also increasing by progress of chemotherapy or molecular-targeted therapy. Now, in addition to the conventional radiotherapy, the multidisciplinary treatment including a newer bisphosphonates or an orthopedic operation has been needed to bone metastasis of lung cancer. We presented the lung cancer case who showed the symptoms in transcervical pathologic fracture and whose QOL was improved by orthopedic surgery, radiotherapy to bone metastasis, chemotherapy, gamma knife surgery, and treatment with zoledronic acid and gefitinib.     

肺癌脑转移的外科治疗

Twelve cases of lung cancer with brain metastasis, which comprised 20% of all lung cancer patients complicated with brain metastasis in the same period in our hospital, underwent resection of both lung and brain lesions. There were 9 men and 3 women. The ages ranged from 29 to 65. The site of metastasis was supratentorial in 11 patients and on the right side in 8. The interval between thoracotomy and craniotomy was 18 days-5 years. There was no operative death. Six patients have survived for more than one year. Surgical approach to lung cancer with brain metastasis has proved to be better in comparison with other methods of treatment. Obviously, adjuvant therapy after surgery may play an important role in improving survival. Whether craniotomy or thoracotomy is first performed depends on the presence or absence of life-threatening neurological symptoms. If the patient's condition allows, the second operation should be performed as soon as possible. It is emphasized that in lung cancer patients, pre- and postoperative routine CT scan of the brain should be regularly done for early detection of brain metastasis. Meanwhile, a timely, planned, staged operation may improve survival.     

乳腺癌肺转移的综合治疗

目的 :分析乳腺癌肺转移综合治疗的疗效及影响生存的预后因素。方法 :65例乳腺癌肺转移患者采用化疗、放疗、内分泌和综合治疗 ,分单一方法治疗组和综合治疗组 ,疗效评价按WHO标准 ,生存率按寿命表法计算。结果 :单一方法治疗组总有效率为 4 6.9% ,综合治疗组总有效率为 72 .7% ,经统计学处理 ,P <0 .0 5 ;两组患者的中位生存期相近 ;内分泌治疗未能提高总有效率。结论 :乳腺癌肺转移综合治疗近期疗效明显优于单一方法治疗 ,但不能延长患者生存期