Division of Neurosurgery, St. Michael's Hospital, Toronto, Canada.
World Neurosurg. 2012 Jan;77(1):201.e9-201.e12. doi: 10.1016/j.wneu.2011.02.017. Epub 2011 Nov 7.
Metastasis of a neuroendocrine tumor to the anterior pituitary is extremely rare.
A 55-year-old woman presented with features suggestive of acromegaly and bone and joint pain. A bone scan suggested metastatic disease. A biopsy of the lumbar spinal lesions revealed a neuroendocrine tumor. Magnetic resonance imaging of the sella demonstrated a lesion with parasellar and suprasellar extensions. Given the need for tissue diagnosis and optic compression, the sellar lesion was removed via transsphenoidal hypophysectomy.
Histology of the biopsy indicated two different tumors in close association. One showed histological features of a pituitary adenoma, whereas the other was a neuroendocrine carcinoma. The pituitary adenoma was immunopositive for growth hormone (GH), whereas the neuroendocrine carcinoma was immunopositive for serotonin and bombesin and immunonegative for GH.
This is the first report of a serotonin and bombesin immunopositive neuroendocrine tumor of unknown primary origin metastatic to a GH-secreting pituitary adenoma, resulting in acromegaly.
神经内分泌肿瘤转移至垂体前叶极为罕见。
一名 55 岁女性出现肢端肥大症和骨骼关节疼痛的特征。骨扫描提示转移性疾病。腰椎病变的活检显示为神经内分泌肿瘤。鞍区磁共振成像显示病变伴有蝶鞍旁和鞍上延伸。鉴于需要组织诊断和视神经受压，通过经蝶窦垂体切除术切除鞍区病变。
活检的组织学表明两种密切相关的不同肿瘤。一种显示垂体腺瘤的组织学特征，另一种是神经内分泌癌。垂体腺瘤对生长激素（GH）呈免疫阳性，而神经内分泌癌对血清素和蛙皮素呈免疫阳性，对 GH 呈免疫阴性。
这是首例报道的由分泌 GH 的垂体腺瘤继发的、起源于未知部位的、分泌血清素和蛙皮素的免疫阳性神经内分泌癌，导致肢端肥大症。
