Kawabata Teppei, Nishida Yasumasa, Oyama Takahiro, Imai Tasuku, Noda Tomoyuki, Mii Shinji, Inoshita Naoko, Maki Hideki
Department of Neurosurgery, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
Department of Pathology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
NMC Case Rep J. 2025 Sep 26;12:427-433. doi: 10.2176/jns-nmc.2024-0227. eCollection 2025.
We present an extremely rare case of lung cancer that metastasized to a gonadotroph pituitary neuroendocrine tumor, along with other organs. A 73-year-old man presented with dysarthria and bitemporal hemianopia. Head magnetic resonance imaging revealed cerebellar infarction and a pituitary tumor. Endoscopic transnasal pituitary tumor resection was performed. Pathologically, the tumor consisted of a well-differentiated neuroendocrine component, suggestive of a pituitary neuroendocrine tumor, alongside a poorly differentiated, highly malignant tumor with invasive growth. One month postoperatively, gadolinium-enhanced head magnetic resonance imaging revealed rapid growth of the residual tumor. Whole-body computed tomography and positron emission tomography revealed a 10-mm lung tumor and multiple muscle and bone metastases. Pathological examination of the pituitary tumor revealed poorly differentiated malignant cells. It was initially hypothesized that the pituitary neuroendocrine tumor had undergone malignant transformation with systemic metastases. However, further pathological examinations revealed steroidogenic factor 1-positive differentiated cells and steroidogenic factor 1-negative, synaptophysin-negative, cytokeratin-7-positive, and thyroid transcription factor-1-positive poorly differentiated malignant cells. The final diagnosis classified the tumor as a poorly differentiated lung adenocarcinoma that had metastasized to a gonadotroph pituitary neuroendocrine tumor, which showed rapid growth. Radiation and chemotherapy were administered; however, the patient died 6 months after surgery. Tumor metastasis to a pituitary neuroendocrine tumor is typically seen in older adults with non-functioning pituitary neuroendocrine tumors and no diabetes insipidus. Hence, clinicians should consider both metastatic pituitary neuroendocrine tumors and tumor metastasis to a pituitary neuroendocrine tumor when diagnosing a rapidly growing pituitary tumor in patients with signs of systemic metastasis.
我们报告了一例极为罕见的肺癌病例，该肺癌转移至促性腺激素垂体神经内分泌肿瘤以及其他器官。一名73岁男性出现构音障碍和双颞侧偏盲。头部磁共振成像显示小脑梗死和垂体肿瘤。进行了内镜经鼻垂体肿瘤切除术。病理检查显示，肿瘤由一个分化良好的神经内分泌成分组成，提示为垂体神经内分泌肿瘤，同时伴有一个分化差、高度恶性且呈浸润性生长的肿瘤。术后1个月，钆增强头部磁共振成像显示残余肿瘤迅速生长。全身计算机断层扫描和正电子发射断层扫描显示有一个10毫米的肺部肿瘤以及多处肌肉和骨转移。垂体肿瘤的病理检查显示为分化差的恶性细胞。最初推测垂体神经内分泌肿瘤发生了恶性转化并伴有全身转移。然而，进一步的病理检查发现了类固醇生成因子1阳性的分化细胞以及类固醇生成因子1阴性、突触素阴性、细胞角蛋白7阳性和甲状腺转录因子1阳性的分化差的恶性细胞。最终诊断将该肿瘤分类为转移至促性腺激素垂体神经内分泌肿瘤的低分化肺腺癌，该垂体神经内分泌肿瘤生长迅速。给予了放疗和化疗；然而，患者在手术后6个月死亡。肿瘤转移至垂体神经内分泌肿瘤通常见于患有无功能垂体神经内分泌肿瘤且无尿崩症的老年人。因此，临床医生在诊断有全身转移迹象的患者中快速生长的垂体肿瘤时，应考虑转移性垂体神经内分泌肿瘤以及肿瘤转移至垂体神经内分泌肿瘤这两种情况。
