少见部位转移为首发症状的肺癌3例临床分析

目的 提高对少见部位转移为首发症状的肺癌患者的诊治水平.方法 对3例已经明确诊断的少见部位转移为首发症状的肺癌患者的临床资料进行分析,并结合文献复习.结果 3例肺癌患者转移的首发症状分别为视物不清——肺腺癌脉络膜转移,多饮、多尿、烦渴——肺腺癌垂体转移,背部肿块——肺鳞癌骨骼肌转移,均为临床少见部位转移.脉络膜转移癌的诊断主要依靠临床症状和影像学检查,影像学包括眼部超声、眼底荧光造影、眼眶CT或核磁,必要时行细针活检.垂体转移肿瘤鞍区MRI呈哑铃样改变,中老年新出现的中枢性尿崩症,应该寻找可能的原发肿瘤.脊柱旁骨骼肌转移表现为疼痛的肿块,诊断可行肌肉超声和MRI确定肿瘤的大小,确诊需行细针穿刺.结论 临床上应加强对少见部位转移为首发症状的肺癌的认识,详细询问病史并结合临床检查及病理,才能获得正确诊断及治疗.     

以中枢性尿崩症为首发症状的垂体转移癌的临诊应对

回顾性分析10例垂体转移癌患者的肿瘤来源、临床特征、影像学特点、诊断与鉴别诊断、治疗及预后。结果显示,10例患者就诊时平均年龄62.0岁,转移灶9例源于肺癌、1例源于乳腺癌。所有患者均以尿崩症起病,部分合并垂体前叶功能减退,以及头痛、视物模糊等占位效应。MRI均显示垂体柄及垂体后叶异常,其中4例表现出特征性"哑铃状"改...     

骨关节病为首发症状肺癌的临床分析

目的 探讨以骨关节病为首发症状肺癌的临床特点,分析误诊原因.方法 回顾性分析本院自2000年1月-2009年8月收治的40例以骨关节病为首发症状的原发性肺癌临床资料.结果 腰骶部疼痛伴下肢痛24例(占60%),单纯下肢疼痛、麻木或踩棉花样感觉10例(占25%),颈肩痛、头晕6例占(15%).结论 以肺外表现为首发症状的肺癌起病隐匿,易误诊、漏诊.提高临床医生对肺癌肺外表现的认识,避免误诊及漏诊,提高早期诊断率.     

老年脉络膜转移癌13例临床特征分析

目的探讨老年脉络膜转移癌(CM)的临床特点。方法对13例老年CM的原发肿瘤特点、眼底表现及辅助检查结果进行分析。结果原发肿瘤中5例(38%)来源于肺癌,6例(46%)来源于乳腺癌,眼底检查见眼球后极部或视盘周围黄白色或灰黄色圆形扁平隆起,部分病例伴有继发性视网膜脱离。A超显示肿瘤的内反射为中等到高,内部结构不规则。B超、CT显示球壁扁平状隆起肿块或限局性增厚,MRI显示肿块T1W呈高于玻璃体的中高信号,T2W为低信号。FFA表现早期不显荧光,而后逐渐显现斑点状荧光,晚期呈斑驳样荧光。ICGA早期呈弱荧光,而后出现弱的荧光斑点。OCT表现为病灶区神经上皮层浆液性脱离。结论原发肿瘤以乳腺癌和肺癌多见,部分病例眼部转移病灶的发现早于原发灶,其中以肺癌多见。影像学检查有助于CM的诊断及鉴别诊断。     

肺外表现为首发症状的肺癌60例报告

肺癌多以呼吸道症状为主要表现,当出现以肺外表现为首发症状时,易漏诊和误诊。现将我院60例以肺外症状为首发表现的肺癌总结如下。1临床资料1.1一般资料本组60例中,男性48例,女性12例;年龄31～83岁,平均56岁。组织学类型:腺癌20例,小细腺未分化癌18例,鳞癌17例;肺泡癌2例;腺鳞癌2例,未定型1例。大体分型:中心型肺癌22例,周围型肺癌37例,纵隔型肺癌1例。1.2首发肺外表现肺癌的特点和误诊时间本组60例中,首发以脑转移26例(以头痛、头昏、抽搐、肢瘫、语言障碍、精神性格改变表现);首发以骨骼系统转移17例(以局部骨痛、截瘫、活动受限表现);首…     

以脑转移症状为首发表现的老年肺癌36例临床分析

目的探讨以脑转移为首发表现的老年肺癌的临床特点。方法分析１９８６～１９９６年收治的以脑转移症状为首发表现的３６例老年肺癌患者。结果腺癌、小细胞肺癌较鳞癌多，外周型肺癌远多于中央型，非手术组中位生存期５个月，手术组中位生存期１４个月，误诊率达７７．８％。结论本形式肺癌误诊率高，预后差，放疗、化疗有一定帮助，脑转移病灶能手术切除的患者预后相对较好     

以精神异常为首发表现肺癌的临床分析

目的提高临床医生对以精神异常为首发表现肺癌的认识。方法分析以精神异常为首发表现的4例肺癌患者资料。结果 4例患者病初都出现不同程度的精神异常。其中3例有病理结果,腺癌2例,小细胞肺癌1例。结论以精神异常为首发表现的肺癌,因其临床表现不典型,易误诊、漏诊,提高对本病的认识有利于早期诊断及治疗。     

以不明原因发热为首发表现的恶性肿瘤69例临床分析

目的探讨以不明原因发热（FUO）为首发表现的恶性肿瘤患者的病因及临床特征。方法回顾性分析我院2000年1月～2007年12月间以FUO为首发表现的69例恶性肿瘤患者的病因、诊断方法和临床表现。结果69例恶性肿瘤患者男女比例为3．06：1,淋巴瘤最多见（占56．5％）,肺癌次之（占24．6％）。多部位穿刺活检有助于淋巴瘤明确诊断,淋巴瘤患者PPD试验阳性率低于结核病,但差异无显著性;89．7％（35／39）的患者有血象下降改变,其中三系细胞均下降比例最高,占36．4％（14／39）,83．9％（26／31）的患者乳酸脱氢酶（LDH）增高。所有肺癌患者均合并有阻塞性肺炎。结论以不明原因发热为首发表现的恶性肿瘤患者中淋巴瘤居首位,肺癌其次,仔细寻找线索有助于明确诊断。     

以脑血栓症状首发的肺癌脑转移15例临床分析

转移性脑肿瘤近年来有逐渐增加的趋势,其中以原发性肺癌为最多,但以脑血栓症状首发的肺癌脑转移尚不多见.1990年4月至1996年5月我院先后收治15例.现报道如下.临床资料一般资料:15例患者,男性11例,女性4例,年龄38～72岁,平均年龄58.3岁.发病时间为5小 时～6天,确诊时间为3～15天.临床特点及脑CT表现:所有病例均以急性脑血栓症状发作,表现左侧肢体偏瘫者7例,右侧肢体     

心脏转移瘤42例临床分析

癌瘤的播散与转移是患者常见的致死原因。心脏转移瘤以肺癌、乳腺瘤、恶性淋巴瘤多见,以肺癌的心脏转移占首位,一般预后不良。为了总结经验,提高诊疗水平．回顾性分析我院1999年-2004年临床资料较完整的转移性心脏肿瘤42例,报告如下。     

Pituitary stalk metastasis from lung cancer, preceding diabetes insipidus--case report and clinical review of the literature]

A 59-year-old woman whose first clinical manifestations were polyuria and polydipsia was admitted to our hospital. Brain MRI showed multiple mass lesions and a thickened pituitary stalk. Chest CT showed hilar and mediastinal lymphadenopathy and a small nodule measuring about 1.5 cm in the apex of the right lung. Histopathological examination revealed adenocarcinoma of the lung, and primary lung cancer with diabetes insipidus secondary to pituitary stalk metastasis was diagnosed. She received systemic chemotherapy and whole-brain irradiation concurrent with intranasal desmopressin (DDAVP) treatment. Although the size of the tumor was reduced, her symptoms did not improve and the same dose of hormone replacement therapy was required. We present this rare case and review the twenty cases of metastatic pituitary lesions arising from lung cancer reported in the literature.     

Twelve cases of pituitary metastasis: a case series and review of the literature

Purpose

The pituitary gland is an unusual site for metastatic spread, but as patients with metastatic malignancy are living longer, it may become more prevalent. Compression of important anatomy adjacent to the sella may produce disabling symptoms and endocrine derangement, leading to significant morbidity.

Methods

An ambispective review of patient records between 2013 and 2017 from three neurosurgical centres was performed. After identifying cases, further investigation was performed to evaluate patient demographic, symptoms at presentation, radiological and histological findings, management, and outcome.

Results

Our investigation identified 12 patients with pituitary metastasis. The average age of the cases was 63.4 years, with breast (n?=?4) and lung (n?=?4) being the most common primary cancers. In half the cases there was a history of metastatic disease, while in one-quarter of cases, pituitary symptoms were the first sign of malignancy. Adenohypophyseal dysfunction (83%), diabetes insipidus (DI) (75%), headache (67%) and visual field defects (67%) were the most common findings at presentation. Glucocorticoid replacement increased the sensitivity for diagnosis of DI. All cases were contrast enhancing on MRI and the endoscopic trans-sphenoidal approach was preferred for biopsy and debulking.

Conclusions

The pituitary should not be overlooked as a site of metastasis and sellar symptoms may be the first presentation of neoplastic disease. Any biochemical or clinical sign of pituitary pathology in a patient with known cancer should raise suspicion for sellar metastasis. Moreover, the development of DI or ophthalmoplegia from any pituitary lesion is suggestive of metastatic disease even in patients with no known primary.

     

Clinical and biochemical characteristic features of metastatic cancer to the sella turcica: an analytical review

Background and objectives

Sellar metastasis is uncommon and poorly characterized as published data include small series of subjects. This study’s goal is to identify unique features that differentiate this entity from other sellar masses such as pituitary macroadenomas.

Methods

Published cases of pathologically-confirmed sellar metastasis along with our experience in such patients over a 6-years period were reviewed (total = 129). As a control group, we reviewed similar data on 55 patients with pituitary macroadenomas managed over the same time-period. Presenting symptoms, pituitary dysfunction were analyzed using univariate, multivariate and receiver operating characteristic (ROC) analyses.

Results

Sellar metastasis has equal gender distribution with a median patient-age of 56 years. The most common primary malignancy was breast cancer (29 %) in women and lung cancer (30 %) in men. Sellar metastasis was the first manifestation of cancer in over 40 % of patients. Common presenting symptoms included headaches, visual field deficits, abnormal eye motility and diabetes insipidus. These symptoms were less frequent among patients with pituitary macroadenomas. Univariate regression analyses showed that headaches, abnormal eye motility, visual field deficits and diabetes insipidus were each predictive of metastatic disease. ROC analysis combining all 4 features revealed an AUC of 0.953 with a sensitivity of 0.818 and a specificity of 0.935. Using the multivariate regression, abnormal eye motility and/or diabetes insipidus independently predicted metastatic disease.

Conclusions

Sellar metastasis should be suspected in patients presenting with sellar masses, abnormal eye motility and/or diabetes insipidus even those without known malignancy since pituitary metastasis can often be the first manifestation of cancer.     

Tumors metastatic to the pituitary gland: case report and literature review

Tumors metastatic to the pituitary gland are an unusual complication of systemic cancer typically seen in elderly patients with diffuse malignant disease. Breast and lung are the commonest sites of the primary tumor, whereas diabetes insipidus is the most frequent symptom at presentation. Their rarity and usually indolent course, as well as the lack of specific clinical and radiological features, impede their differentiation from other more common sellar area lesions, particularly when history of malignancy is absent. Management of these patients may also be very difficult because the prognosis depends on the course of the primary neoplasm. A 68-yr-old man, with no history of malignancy, presented with recent onset of hypopituitarism, mild diabetes insipidus, headaches, left oculomotor nerve palsy, and progressive bilateral deterioration of visual acuity and visual fields. Magnetic resonance imaging revealed a large sellar mass compressing the optic chiasm and invading the left cavernous sinus, whereas a prolactin elevation at 438.6 ng/ml (19.73 nmol/liter) was noted. Decompression of the sellar region was attempted, and pathology disclosed a metastatic hepatocellular carcinoma. On postoperative investigation, primary liver tumor was identified and confirmed by biopsy. The patient improved transiently but died 3 months after diagnosis because of deterioration of the liver disease. The relevant literature is reviewed in light of this unusual case, illustrating the problems in the diagnosis and management of patients with metastasis to the pituitary.     

Diabetes insipidus in a patient with small-cell lung cancer: a paradox?

We observed oat-cell lung carcinoma in a man who presented with diabetes insipidus. The chest radiograph showed a suspect nodule within a context of major nicotine addiction. Histopathological examination of the transbronchial biopsy confirmed the diagnosis of oat-cell carcinoma. Brain CT revealed metastasis to the pituitary gland and the pituitary stalk. Vasopressin was undetectable. This case illustrates an uncommon clinical presentation of small-cell lung carcinoma. Oat-cell carcinoma can modify osmoregulation in two different ways. Only sporadic cases of neurogenic diabetes insipidus due to the primary involvement of small-cell lung carcinoma have been reported. More often, this type of lung tumor is associated with inappropriate antidiuretic hormone secretion.     

Intracranial metastatic disease rarely involves the pituitary: retrospective analysis of 935 metastases in 155 patients and review of the literature

We present a case report of a patient recently treated at our institution for an isolated non-small cell lung cancer metastatic lesion to the sella, report the lack of involvement of the pituitary gland in a large single-institution series of treated intracranial parenchymal metastases, and review the pertinent literature. We reviewed cranial imaging studies (CT and MRI) for 935 metastases in 155 patients treated at our institution over the previous 3 years for intracranial metastatic disease. Special attention was paid to the skull base to document the presence of any metastatic disease involving the pituitary gland, infundibular stalk, sella turcica (including anterior and posterior clinoids), or diaphragm sellae. We found no other involvement of the pituitary gland or other sellar structures by metastatic disease in this series. Intracranial metastatic disease rarely involves the pituitary gland and infundibular stalk parenchyma, suggesting that this structure may be safely omitted from the treatment field during WBRT and prophylactic cranial irradiation (PCI). This treatment approach should reduce the late sequelae of treatment to this critical organ.     

A case of central diabetes insipidus caused by metastatic small cell lung cancer]

A 58-year-old man was admitted to our hospital because of cough, polydipsia and polyuria. Chest CT films showed mediastinal lymphadenopathy, nodules in the lung fields, and pleural effusion. Histopathologic examination of transbronchial biopsy specimens showed oat cell carcinoma. MRI films revealed tumorous swelling of the pituitary stalk. Central diabetes insipidus caused by pituitary metastasis of small cell lung cancer was diagnosed. After treatment with whole-brain irradiation and chemotherapy, the size of the swollen pituitary stalk was reduced and his urine volume decreased. He died of respiratory insufficiency 15 months after the initial diagnosis. No recurrence of pituitary metastasis was apparent. This was a rare case of central diabetes insipidus caused by pituitary metastasis of small cell lung cancer successfully treated with radiotherapy and chemotherapy.     

Diabetes insipidus and adrenal insufficiency in a patient with metastatic breast cancer

A patient previously treated for bilateral breast cancer with mastectomy, radiation therapy and in remission on hormonal therapy for more than five years presented with abdominal symptoms from breast cancer relapse. She developed inappropriate polyuria and hypernatraemia, which responded to desmopressin. In combination with the absence of a high signal from the posterior lobe of the pituitary on MRI , these data indicated the presence of partial central diabetes insipidus. The anterior pituitary showed partial failure (low follicle-stimulating hormone, luteinising hormone and insulin-like growth factor-1 levels). Furthermore, primary adrenal insufficiency had developed, ascribed to bilateral tumour invasion of the adrenals. This rare combination of endocrinological failures in a patient with metastatic breast cancer is discussed.     

Central diabetes insipidus caused by pituitary metastasis of lung cancer]

A 53-year-old man admitted for thirst, polyposia, and polyuria. Large cell lung cancer T3N2M1 (Stage IV), and central diabetes insipidus caused by pituitary metastasis of lung cancer, were diagnosed. We gave him desmopressin acetate, and chemotherapy with paclitaxel and carboplatin. But pituitary metastasis increased and invaded the hypothalamus. After irradiation of the pituitary and hypothalamus, metastatic focus diminished and desmopressin acetate was tapered.     

Atypical diabetes insipidus in small cell lung cancer. Paraneoplastic syndrome or metastatic disease?

A 54-year old man was admitted with extensive disease: small cell lung cancer, and severe central diabetes insipidus. Computer assisted tomography of the brain was negative for metastatic spread to the hypothalamus or pituitary gland. Basic levels of antidiuretic hormone were within normal limits, yet the hormone failed to increase secondary to elevated osmotic load. We hypothesize that in this patient, hypothalamus and pituitary gland were morphologically intact, and that diabetes insipidus was induced by the inhibitory action of ectopic opiates on the release of antidiuretic hormone. Nevertheless, since post-mortem studies were refused, metastatic diabetes insipidus could not be definitely excluded, in which case, the source of plasmatic antidiuretic hormone would be the tumor itself.