Pituitary carcinoma presenting with multiple metastases: case report

Pituitary carcinoma, an uncommon tumor in adults, generally presents with craniospinal and systemic metastases. We report a case of pituitary carcinoma with multiple craniospinal metastases in a child. A 9-year-old girl, who had had a ventriculoperitoneal shunt operation 3 years ago, presented with complaints of progressive visual disturbance, headache, speech difficulty, and gait disturbance for the past 2 months. Neurological examination revealed papilledema, visual loss, and dysarthria. Cranial magnetic resonance imaging revealed a large contrast-enhanced tumor in the left frontal region together with multiple lesions in the sellar-parasellar region and posterior fossa. Multiple intraspinal contrast-enhanced metastatic lesions were also seen. Histopathological and immunohistochemical examination of the excised left frontal mass revealed pituitary carcinoma. Treatment with cyclic temozolomide was started after the operation, but the patient died after 2 months without response to medical therapy. This is the first pediatric case, to the authors' knowledge, of a pituitary carcinoma with widespread intracranial and intraspinal metastases.