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An ACTH-producing pituitary carcinoma developing Cushing's disease.

T Masuda1, Y Akasaka, Y Ishikawa

  • 1Department of Pathology, Toho University School of Medicine, Tokyo, Japan. masudatk@med.toho-u.ac.jp

Pathology, Research and Practice
|April 30, 1999
PubMed
Summary

This case report details an ACTH-producing pituitary carcinoma initially misdiagnosed as adenoma. Autopsy confirmed widespread metastases, highlighting the importance of Ki-67 in assessing pituitary tumor malignancy.

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Area of Science:

  • Endocrinology
  • Oncology
  • Neuropathology

Background:

  • Cushing's disease can be caused by pituitary tumors, typically adenomas.
  • Pituitary carcinomas are rare but aggressive tumors with metastatic potential.

Observation:

  • A 59-year-old man with Cushing's disease had a pituitary tumor initially diagnosed as a chromophobe adenoma.
  • Two years post-surgery, pulmonary metastases were detected, leading to autopsy.
  • Autopsy revealed residual pituitary tumor with extensive systemic metastases.

Findings:

  • Immunohistochemistry confirmed ACTH production by the pituitary tumor cells.
  • High Ki-67 expression was observed in both the surgically removed and autopsied tumors.
  • The Ki-67 labeling index indicated significant invasive and proliferative potential.

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Implications:

  • This case underscores the diagnostic challenges in distinguishing aggressive pituitary adenomas from carcinomas.
  • High Ki-67 expression serves as a crucial biomarker for predicting pituitary tumor invasiveness and metastatic risk.
  • Accurate diagnosis and assessment of proliferative potential are vital for managing patients with pituitary tumors.