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Surgical Treatment of an Endolymphatic Sac Tumor
Published on: May 26, 2023
Pituitary carcinoma with endolymphatic sac metastasis
Irida Balili1, Steven Sullivan, Paul Mckeever
1Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA.
Pituitary
|May 7, 2013
Summary
This is the first reported case of pituitary carcinoma in the endolymphatic sac region. The metastatic tumor showed a distinct prolactin-producing cell population, suggesting a separate clonal origin from the original GH/prolactin-producing pituitary adenoma.
Area of Science:
- Endocrinology
- Oncology
- Neurosurgery
Background:
- Pituitary carcinoma is rare and poorly understood, defined by non-contiguous metastasis.
- Malignant transformation mechanisms remain largely unknown.
- Acromegaly and elevated growth hormone (GH) are common in pituitary macroadenomas.
Observation:
- A 15-year-old male with a GH/prolactin-producing pituitary macroadenoma developed acromegaly.
- Initial treatment included surgery and radiation, with Octreotide controlling GH and IGF-1.
- A metastatic lesion in the endolymphatic sac region was diagnosed in 2009 as a prolactin-producing pituitary carcinoma.
Findings:
- The metastatic carcinoma was purely prolactin-producing, contrasting with the original GH/prolactin-producing tumor.
- Immunohistochemistry revealed a low MIB-1 proliferation index (0-5%) in the metastatic lesion.
- The original pituitary tumor and the metastatic lesion showed similar GH and prolactin positivity upon later examination.
Implications:
- This case represents the first documented instance of pituitary carcinoma in the endolymphatic sac.
- The distinct cell populations suggest the metastasis may have arisen from a separate clone.
- Further research into clonal evolution is needed to understand pituitary carcinoma development.
