Bailey David, Mau Christine, Zacharia Brad
Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
Cureus. 2021 Aug 30;13(8):e17574. doi: 10.7759/cureus.17574. eCollection 2021 Aug.
The sellar and parasellar regions are a rare site of brain metastasis, most commonly from breast and lung cancer. Pituitary metastasis (PM) often presents as the first sign of metastatic disease but may herald early disseminated cancer. The diagnosis of PM requires differentiation from a benign pituitary adenoma. Although this may be proven definitively via surgical biopsy, a constellation of clinical findings including oculomotor palsy, visual disturbances, retroorbital pain, and diabetes insipidus is more suggestive of PM. Imaging is neither sensitive nor specific for differentiation but may inform the broader clinical picture. Due to its rarity, treatment guidelines for PM lack consensus, often including a mixture of radiation and surgery. Gross resection is challenging because of the vascular, invasive nature of these lesions. Stereotactic radiosurgery may be used to good effect either alone or in addition to resection. Even with treatment, the prognosis is poor. In this article, we present the third reported case of urothelial carcinoma metastasis to the pituitary. In addition, we review the clinical presentation, diagnosis, and treatment options including surgical resection and radiosurgery.
鞍区和鞍旁区域是脑转移瘤的罕见部位，最常见于乳腺癌和肺癌转移。垂体转移瘤（PM）常作为转移性疾病的首发症状出现，但也可能预示着早期播散性癌症。PM的诊断需要与良性垂体腺瘤相鉴别。虽然这可以通过手术活检明确证实，但包括动眼神经麻痹、视觉障碍、眶后疼痛和尿崩症在内的一系列临床症状更提示为PM。影像学检查对于鉴别诊断既不敏感也不特异，但可以提供更全面的临床情况。由于其罕见性，PM的治疗指南缺乏共识，通常包括放疗和手术的综合应用。由于这些病变具有血管丰富、侵袭性的特点，完整切除具有挑战性。立体定向放射外科手术单独使用或与切除术联合使用可能会取得良好效果。即使经过治疗，预后也很差。在本文中，我们报告了第三例尿路上皮癌转移至垂体的病例。此外，我们还回顾了其临床表现、诊断以及包括手术切除和放射外科手术在内的治疗选择。
