Pituitary carcinoma with malignant growth from first presentation and fulminant clinical course--case report and review of the literature.

CONTEXT

Although pituitary adenomas are common, pituitary carcinoma is a very rare condition.

OBJECTIVE

We report on a 48-yr-old male presenting with pituitary carcinoma with malignant growth from the beginning and a fulminant clinical course and give an overview of the previously reported cases, paying special attention to clinical and histological parameters that may predict the clinical course.

METHODS

We performed a MEDLINE search for previously published cases of pituitary carcinoma and analyzed the clinical, laboratory, and radiological findings.

RESULTS

Ki-67 index and the number of metastatic diseases found on postmortem examination were significantly increased in patients with no treatment response compared to those with some treatment response (P = 0.03 and P = 0.02, respectively). In contrast, time to occurrence of metastatic disease and time to death were significantly shortened in patients with no treatment response (P = 0.01 and P = 0.02, respectively). No differences were found between the two groups for gender distribution, tumor size, mitotic activity assessed as the number of mitotic figures per 10 high-power fields, and number of locations of metastatic disease.

CONCLUSION

Frequently relapsing, invasive adenoma should raise a suspicion of a malignant disease. Clinically only the presence of metastases is a criterion of malignancy. A high Ki-67 index in the pituitary carcinoma and early manifestation of metastatic disease appear to predict rapid disease progression.