Pituitary gland metastases from renal cell carcinoma: A case report and literature update

Pituitary metastases are rare and metastatic pituitary lesions secondary of renal carcinoma are extremely rare. These lesions can be mistaken for pituitary adenomas and diagnosis can be very difficult. We report a 67-year-old Italian female complained of headache and visual impairment resulting from a sellar lesion with suprasellar extension. A transsphenoidal biopsy was performed and histological examination revealed a metastasis of renal cell carcinoma. Few casesof this type of pituitary metastasis is described and every treatment is palliative for the life of such patient. We updateliterature and discuss the clinical and radiological features and treatment of this case. Abbreviations: CT: Computed Tomography, MRI: Magnetic Resonance Introduction Metastatic tumors involving the pituitary gland account for 1% of all pituitary tumor resections and for 1% to 25% at autopsy. Any malignant tumour can metastasize to the pituitary gland, but breast and lung cancer are the most prevalent, accounting for two thirds of the cases [1-3]. McCormik described a surgical series of 780 cases of transsphenoidal surgery with only six cases (0,8%) of pituitary secondary lesions [4]. Metastasis of renal cell carcinoma is extremely rare. Komninos reported a series of 360 cases in which 2.6% of metastatic pituitary lesions were secondary spread of renal carcinoma [5]. We present a case of a renal carcinoma metastatic to the pituitary gland and an updated review of the literature, discussing clinical and radiological characteristics of these lesions. Case report We present a 67-year-old Italian female complained of severe headache and visual impairment. For increasing of headache she was transferred to our department. There was no history of trauma or other systemic disease. Ophtalmological examination revealed deteriorating right vision and bitemporal hemianopsy. Ocular motion was normal and there was neither paresis nor sensory disturbance of the extremities. Endocrinological study indicated panhypopituitarism. Magnetic resonance (MR) imaging showed on T1-weighted image an isointense intrasellar mass with suprasellar extension (Figure 1), which compression of the optic chiasm and heterogeneous enhancement after administration of gadolinium. MR angiogram detected displacement of the carotid siphon bilaterally with normal signal intensity of flow. Computed tomography (CT) scan demonstrated clear demineralization and ballooning of the sellar floor and upper clivus (Figure 2). The patient underwent a trans-sphenoidal tumor biopsy (Figure 3A-3C). Histological examination revealed a metastasis of renal cell carcinoma. Post-operatively CT scan abdomen revealed renal mass without signs of other metastatic site. She underwent a right radical nephrectomy, radiotherapy with local irradiation of 41 Grey to the pituitary region and replacement hormonal therapy (Table 1). Correspondence to: Domenico Murrone, Department of Neurosurgery, “San Salvatore” City Hospital, via Vetoio, Coppito, L’Aquila 67100, Italy, E-mail: [email protected]