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World Journal of Surgical Oncology

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Open Access 01-12-2009 | Review

ACTH-producing carcinoma of the pituitary with refractory Cushing's Disease and hepatic metastases: a case report and review of the literature

Authors: Scott N Pinchot, Rebecca Sippel, Herbert Chen

Published in: World Journal of Surgical Oncology | Issue 1/2009

Abstract

Background

Pituitary carcinomas are rare neuroendocrine tumors affecting the adenohypophysis. The hallmark of these lesions is the demonstration of distant metastatic spread. To date, few well-documented cases have been reported in the literature.

Case presentation

Here, we report the case of a fatal pituitary carcinoma evolving within two years from an adrenocorticotrophic hormone (ACTH)-secreting macroadenoma and review the global literature regarding this rare neuroendocrine tumor.

Conclusion

Pituitary carcinomas are extremely rare neoplasms, representing only 0.1% to 0.2% of all pituitary tumors. To date, little is understood about the molecular basis of malignant transformation. The latency period between initial presentation of a pituitary adenoma and the development of distal metastases marking carcinoma is extremely variable, and some patients may live well over 10 years with pituitary carcinoma.

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Asa S, Ezzat S: The cytogenesis and pathogenesis of pituitary adenomas. Endocr Rev. 1998, 19: 798-827. 10.1210/er.19.6.798.PubMed

Landman R, Horwith M, Peterson R, Khandji A, Wardlaw S: Long-term survival with ACTH-secreting carcinoma of the pituitary: a case report and review of the literature. J Clin Endocrinol Metab. 2002, 87: 3084-3089. 10.1210/jc.87.7.3084.CrossRefPubMed

Ragel B, Couldwell W: Pituitary carcinoma: a review of the literature. Neurosurg Focus. 2004, 16: E7-10.3171/foc.2004.16.4.8.PubMed

Pernicone P, Scheithauer B, Sebo T, Kovacs K, Horvath E, Young WJ, Lloyd R, Davis D, Guthrie B, Schoene W: Pituitary carcinoma: a clinicopathologic study of 15 cases. Cancer. 1997, 79: 804-812. 10.1002/(SICI)1097-0142(19970215)79:4<804::AID-CNCR18>3.0.CO;2-3.CrossRefPubMed

Scheithauer B, Kovacs K, Laws EJ, Randall R: Pathology of invasive pituitary tumors with special reference to functional classification. J Neurosurg. 1986, 65: 733-744.CrossRefPubMed

Della Casa S, Corsello S, Satta M, Rota C, Putignano P, Vangeli V, Colosimo C, Anile C, Barbarino A: Intracranial and spinal dissemination of an ACTH secreting pituitary neoplasia. Case report and review of the literature. Ann Endocrinol (Paris). 1997, 58: 503-509.

Kemink S, Wesseling P, Pieters G, Verhofstad A, Hermus A, Smals A: Progression of a Nelson's adenoma to pituitary carcinoma; a case report and review of the literature. J Endocrinol Invest. 1999, 22: 70-75.CrossRefPubMed

Brown R, Muzzafar T, Wollman R, Weiss R: A pituitary carcinoma secreting TSH and prolactin: a non-secreting adenoma gone awry. Eur J Endocrinol. 2006, 154: 639-643. 10.1530/eje.1.02141.CrossRefPubMed

Koyama J, Ikeda K, Shose Y, Kimura M, Obora Y, Kohmura E: Long-term survival with non-functioning pituitary carcinoma – case report. Neurol Med Chir (Tokyo). 2007, 47: 475-478. 10.2176/nmc.47.475.CrossRef

10.

Guastamacchia E, Triggiani V, Tafaro E, De Tommasi A, De Tommasi C, Luzzi S, Sabbà C, Resta F, Terreni M, Losa M: Evolution of a prolactin-secreting pituitary microadenoma into a fatal carcinoma: a case report. Minerva Endocrinol. 2007, 32: 231-236.PubMed

11.

Brown R, Wollman R, Weiss R: Transformation of a pituitary macroadenoma into to a corticotropin-secreting carcinoma over 16 years. Endocr Pract. 2007, 13: 463-471.CrossRefPubMed

12.

Manahan M, Dackiw A, Ball D, Zeiger M: Unusual case of metastatic neuroendocrine tumor. Endocr Pract. 13: 72-76.

13.

Tena-Suck M, Salinas-Lara C, Sánchez-García A, Rembao-Bojórquez D, Ortiz-Plata A: Late development of intraventricular papillary pituitary carcinoma after irradiation of prolactinoma. Surg Neurol. 2006, 66: 527-533. 10.1016/j.surneu.2006.02.039. discussion 533CrossRefPubMed

14.

Fadul C, Kominsky A, Meyer L, Kingman L, Kinlaw W, Rhodes C, Eskey C, Simmons N: Long-term response of pituitary carcinoma to temozolomide. Report of two cases. J Neurosurg. 2006, 105: 621-626. 10.3171/jns.2006.105.4.621.CrossRefPubMed

15.

Kumar K, Wilson J, Li Q, Phillipson R: Pituitary carcinoma with subependymal spread. Can J Neurol Sci. 2006, 33: 329-332.CrossRefPubMed

16.

Sivan M, Nandi D, Cudlip S: Intramedullary spinal metastasis (ISCM) from pituitary carcinoma. J Neurooncol. 2006, 80: 19-20. 10.1007/s11060-006-9156-7.CrossRefPubMed

17.

Mamelak AN, Carmichael JD, Park P, Bannykh S, Fan X, Bonert HV: Atypical pituitary adenoma with malignant features. Pituitary. 2008,

18.

Siddiqui A, Bashir S: Giant pituitary macroadenoma at the age of 4 months: case report and review of the literature. Childs Nerv Syst. 2006, 22: 290-294. 10.1007/s00381-005-1179-4.CrossRefPubMed

19.

Garrão A, Sobrinho L, Pedro-Oliveira , Bugalho M, Boavida J, Raposo J, Loureiro M, Limbert E, Costa I, Antunes J: ACTH-producing carcinoma of the pituitary with haematogenic metastases. Eur J Endocrinol. 1997, 137: 176-180. 10.1530/eje.0.1370176.CrossRefPubMed

20.

Gaffey T, Scheithauer B, Lloyd R, Burger P, Robbins P, Fereidooni F, Horvath E, Kovacs K, Kuroki T, Young WJ: Corticotroph carcinoma of the pituitary: a clinicopathological study. Report of four cases. J Neurosurg. 2002, 96: 352-360.CrossRefPubMed

21.

Zafar M, Mellinger R, Chason J: Cushing's disease due to pituitary carcinoma. Henry Ford Hosp Med J. 1984, 32: 61-66.PubMed

22.

Zhao D, Tomono Y, Nose T: Expression of P27kip1 and Ki-67 in pituitary adenomas: an investigation of marker of adenoma invasiveness. Acta Neurochir (Wien). 1999, 141: 187-192. 10.1007/s007010050285.CrossRef

23.

Vaquero J, Herrero J, Cincu R: Late development of frontal prolactinoma after resection of pituitary tumor. J Neurooncol. 2003, 64: 255-258. 10.1023/A:1025672617249.CrossRefPubMed

24.

Zahedi A, Booth G, Smyth H, Farrell W, Clayton R, Asa S, Ezzat S: Distinct clonal composition of primary and metastatic adrencorticotrophic hormone-producing pituitary carcinoma. Clin Endocrinol (Oxf). 2001, 55: 549-556. 10.1046/j.1365-2265.2001.01322.x.CrossRef

25.

Matoso A, Zhou Z, Hayama R, Flesken-Nikitin A, Nikitin A: Cell lineage-specific interactions between Men1 and Rb in neuroendocrine neoplasia. Carcinogenesis. 2008, 29: 620-628. 10.1093/carcin/bgm207.CrossRefPubMed

26.

Harvey M, Vogel H, Lee E, Bradley A, Donehower L: Mice deficient in both p53 and Rb develop tumors primarily of endocrine origin. Cancer Res. 1995, 55: 1146-1151.PubMed

27.

Williams B, Schmitt E, Remington L, Bronson R, Albert D, Weinberg R, Jacks T: Extensive contribution of Rb-deficient cells to adult chimeric mice with limited histopathological consequences. EMBO J. 1994, 13: 4251-4259.PubMedCentralPubMed

28.

Hinton D, Hahn J, Weiss M, Couldwell W: Loss of Rb expression in an ACTH-secreting pituitary carcinoma. Cancer Lett. 1998, 126: 209-214. 10.1016/S0304-3835(98)00013-5.CrossRefPubMed

29.

Thapar K, Scheithauer B, Kovacs K, Pernicone P, Laws EJ: p53 expression in pituitary adenomas and carcinomas: correlation with invasiveness and tumor growth fractions. Neurosurgery. 1996, 38: 765-770. 10.1097/00006123-199604000-00027. discussion 770–761CrossRefPubMed

30.

Sonino N, Zielezny M, Fava G, Fallo F, Boscaro M: Risk factors and long-term outcome in pituitary-dependent Cushing's disease. J Clin Endocrinol Metab. 1996, 81: 2647-2652. 10.1210/jc.81.7.2647.PubMed

31.

Locatelli M, Vance M, Laws E: Clinical review: the strategy of immediate reoperation for transsphenoidal surgery for Cushing's disease. J Clin Endocrinol Metab. 2005, 90: 5478-5482. 10.1210/jc.2004-2436.CrossRefPubMed

32.

Nelson D, Meakin J, Dealy Jj, Matson D, Emerson Kj, Thorn G: ACTH-producing tumor of the pituitary gland. N Engl J Med. 1958, 259: 161-164.CrossRefPubMed

33.

Assié G, Bahurel H, Coste J, Silvera S, Kujas M, Dugué M, Karray F, Dousset B, Bertherat J, Legmann P, Bertagna X: Corticotroph tumor progression after adrenalectomy in Cushing's Disease: A reappraisal of Nelson's Syndrome. J Clin Endocrinol Metab. 2007, 92: 172-179. 10.1210/jc.2006-1328.CrossRefPubMed

34.

Jenkins P, Trainer P, Plowman P, Shand W, Grossman A, Wass J, Besser G: The long-term outcome after adrenalectomy and prophylactic pituitary radiotherapy in adrenocorticotropin-dependent Cushing's syndrome. J Clin Endocrinol Metab. 1995, 80: 165-171. 10.1210/jc.80.1.165.PubMed

35.

Thompson S, Hayman A, Ludlam W, Deveney C, Loriaux D, Sheppard B: Improved quality of life after bilateral laparoscopic adrenalectomy for Cushing's disease: a 10-year experience. Ann Surg. 2007, 245: 790-794. 10.1097/01.sla.0000251578.03883.2f.PubMedCentralCrossRefPubMed

36.

Evers BM, Ishizuka J, Townsend CM, Thompson JC: The human carcinoid cell line, BON. A model system for the study of carcinoid tumors. Ann N Y Acad Sci. 1994, 733: 393-406. 10.1111/j.1749-6632.1994.tb17289.x.CrossRefPubMed

Title: ACTH-producing carcinoma of the pituitary with refractory Cushing's Disease and hepatic metastases: a case report and review of the literature
Authors: Scott N Pinchot
Rebecca Sippel
Herbert Chen
Publication date: 01-12-2009
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2009
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/1477-7819-7-39

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

ACTH-producing carcinoma of the pituitary with refractory Cushing's Disease and hepatic metastases: a case report and review of the literature

Abstract

Background

Case presentation

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Case presentation

Conclusion

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