ABSTRACT
Los estudios de medicina nuclear permiten en tumor neuroendocrino (TNE) de origen desconocido la búsqueda del tumor primario y estadificación de la enfermedad
Nuclear medicine studies allow neuroendocrine tumor (NET) of unknown origin to search for the primary tumor and staging the disease
Estudos de medicina nuclear permitem o tumor neuroendócrino (NET) de origem desconhecida para a pesquisa do tumor primário e o estadiamento da doença
Subject(s)
Humans , Female , Aged , Scalp/pathology , Somatostatin/analogs & derivatives , Carcinoma, Neuroendocrine/secondary , Carcinoma, Neuroendocrine/diagnostic imaging , Radionuclide ImagingABSTRACT
SUMMARY Metastasis to the pituitary gland is an unusual situation in clinical practice, but the frequency thereof is increasing due to the increased survival of cancer patients, and greater availability of imaging. In most cases, they are found between the sixth and seventh decades of life, as determined in image examination of patients with known malignant neoplasm, but, generally, asymptomatic with respect to pituitary involvement. The most common primary sites are breast in women and lung in men. We present the case of a 64-year-old patient with clinical visual changes, polyuria, polydipsia, and decreased level of consciousness whose tests showed pan-hypopituitarism, hypernatremia and low urine specific gravity, and extensive mass in sellar region. Diabetes insipidus was confirmed and treated, corticotrophic and thyroid deficits were corrected and then the patient underwent resection by transsphenoidal surgery. The histopathological and immunohistochemistry analysis revealed pituitary metastasis of lung neuroendocrine tumor. Subsequently, a chest CT scan showed pulmonary mass consistent with primary neoplasm. Despite the water and electrolyte correction and intravenous glucocorticoid replacement, the patient continued to show decreased level of consciousness due to compression of the brain stem by the pituitary mass, evolving to death. The purpose is to call attention to the differential diagnosis of invasive lesions of the sellar region, mainly in individuals over 50 years and/or when associated with diabetes insipidus, as it may be a case of metastasis, although there is no known primary neoplasm. Arch Endocrinol Metab. 2015;59(6):548-53.
Subject(s)
Female , Humans , Middle Aged , Carcinoma, Neuroendocrine/secondary , Lung Neoplasms/pathology , Pituitary Neoplasms/secondary , Biopsy , Consciousness , DNA-Binding Proteins/isolation & purification , Fatal Outcome , ImmunohistochemistrySubject(s)
Female , Humans , Middle Aged , Carcinoma, Large Cell/secondary , Carcinoma, Neuroendocrine/secondary , Cerebellar Neoplasms/secondary , Lung Neoplasms/pathology , Meningeal Neoplasms/secondary , Pituitary Neoplasms/secondary , Cerebellopontine Angle , Carcinoma, Large Cell/diagnosis , Carcinoma, Neuroendocrine/diagnosis , Cerebellar Neoplasms/diagnosis , Magnetic Resonance Imaging , Meningeal Neoplasms/diagnosis , Pituitary Neoplasms/diagnosis , Skull Base Neoplasms/diagnosis , Skull Base Neoplasms/secondary , Tomography, X-Ray ComputedABSTRACT
Relatar o caso de um paciente de 43 anos com metástase de carcinoma neuroendócrino intracraniana e intra-orbitária, cujas primeiras manifestações foram oftalmológicas. Relato de caso. Remissão temporária do quadro clínico após um ciclo de quimioterapia. A análise histopatológica e a imuno-histoquímica foram sugestivas de carcinoma neuroendócrino. A regressão das manifestações clínicas após quimioterapia e o óbito posterior aos ciclos de quimioterapia nos faz pensar na necessidade da criação de protocolos de tratamento para essa forma de neoplasia, levando em consideração, fatores locais e/ou sistêmicos.