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      Giant sellar metastasis from renal cell carcinoma : A case report and literature review

      case-report
      , PhD, , MD, , MD , , MD
      Medicine
      Wolters Kluwer Health
      pan-hypopituitarism, renal cell carcinoma, sellar metastasis, visional function

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          Abstract

          Rationale:

          Sellar metastasis is a rare and complex disease whose clinical features are strongly associated with the primary malignancy. Here, we present a rare case of giant sellar metastasis spread from renal cell carcinoma (RCC).

          Patient concerns:

          A 30-year-old Chinese woman was admitted to our Hospital, reporting headache, nasal congestion, nausea, vomiting, and a sharp decline in her right eye vision.

          Diagnoses:

          Brain magnetic resonance imaging (MRI) revealed an invasive sellar mass with cavernous sinus and nasal cavity extension. Additionally, the patient had a medical history of right radical nephrectomy for clear-cell RCC.

          Interventions:

          The patient underwent a successful subtotal resection of the tumor. Final pathological diagnosis confirmed sellar metastasis from RCC. After surgery, the patient was referred to our medical oncology department and received further systemic therapy.

          Outcomes:

          No light perception remained in her right eye even after prompt surgical decompression. Follow-up MRI showed subtotal resection of the giant sellar metastasis.

          Lesson:

          Sellar metastasis, although rare, should be particularly considered for elderly patients with deteriorating visual function and medical histories of cancer.

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          Most cited references25

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          Symptomatic pituitary metastases.

          The diagnosis and treatment of metastasis to the pituitary gland can be difficult to determine. The goal of this study was to analyze the clinical presentation, treatment, and prognosis of patients who presented with symptomatic pituitary metastasis. The cases of 36 patients with symptomatic pituitary metastases were reviewed. The most common primary cancers were breast (33%) and lung (36%). The presenting symptoms included diabetes insipidus, anterior pituitary insufficiency, and retroorbital pain. The overall median length of patient survival following diagnosis of pituitary metastasis was 180 days. In 20 patients (56%), symptoms stemming from pituitary metastasis were the first manifestation of illness. Local control of tumor was associated with significant improvement in survival times (p < 0.05) and amelioration of disabling symptoms including painful ophthalmoplegia and visual field deficits. Aggressive treatment including both surgical decompression and radiation therapy improves the quality of life in patients suffering from symptomatic pituitary metastasis.
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            Metastases to the pituitary gland.

            Only 1% of all pituitary surgeries are performed to treat tumors that have metastasized to the pituitary gland; however, in certain cases of malignant neoplasms pituitary metastases do occur. Breast and lung cancers are the most common diseases that metastasize to the pituitary. Breast cancer metastasizes to the pituitary especially frequently, with reported rates ranging between 6 and 8% of cases. Most pituitary metastases are asymptomatic, with only 7% reported to be symptomatic. Diabetes insipidus, anterior pituitary dysfunction, visual field defects, headache/pain, and ophthalmoplegia are the most commonly reported symptoms. Diabetes insipidus is especially common in this population, occurring in between 29 and 71% of patients who experience symptoms. Differentiation of pituitary metastasis from other pituitary tumors based on neuroimaging alone can be difficult, although certain features, such as thickening of the pituitary stalk, invasion of the cavernous sinus, and sclerosis of the surrounding sella turcica, can indicate metastasis to the pituitary gland. Overall, neurohypophysial involvement seems to be most prevalent, but breast metastases appear to have an affinity for the adenohypophysis. Differentiating metastasis to the pituitary gland from bone metastasis to the skull base, which invades the sella turcica, can also be difficult. In metastasis to the pituitary gland, surrounding sclerosis in the sella turcica is usually minimal compared with metastasis to the skull base. Treatment for these tumors is often multimodal and includes surgery, radiation therapy, and chemotherapy. Tumor invasiveness can make resection difficult. Although surgical series have not shown any significant survival benefits given by tumor resection, the patient's quality of life may be improved. Survival among these patients is poor with mean survival rates reported to range between 6 and 22 months.
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              Metastatic involvement of the pituitary gland: a systematic review with pooled individual patient data analysis.

              To report a rare case of pituitary metastasis (PM) from hepatocellular carcinoma (HCC) and help better understand the incidence of PM and its most common presenting symptoms through a pooled individual patient data analysis.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                November 2018
                21 November 2018
                : 97
                : 47
                : e13376
                Affiliations
                Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
                Author notes
                []Correspondence: Xinjie Bao, Department of Neurosurgery, Pituitary Center, Peking Union Medical College Hospital, 1 Shuaifuyuan, Wangfujing, Beijing 100730, China (e-mail: baoxinjie1@ 123456pumch.cn ).
                Article
                MD-D-18-05958 13376
                10.1097/MD.0000000000013376
                6392949
                30461658
                2475d67d-637b-487d-ae7a-835616368ce0
                Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                : 22 August 2018
                : 31 October 2018
                Categories
                5300
                Research Article
                Clinical Case Report
                Custom metadata
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                pan-hypopituitarism,renal cell carcinoma,sellar metastasis,visional function

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