A journey of neuroendocrine carcinoma of the brain from the primary to metastatic tumor

The neuroendocrine tumors most commonly originate in the lung, liver, and gastrointestinal tract. They can be graded into a three-tiered system depending on their proliferation index. These tumors frequently metastasize to the regional lymph nodes. Neuroendocrine tumors of the brain are very rare. Most of them are metastatic and a handful of cases are primary. Hereby, we present a case of brain neuroendocrine carcinoma, which was solitary with no evidence of the primary tumor in the body at the time of neurosurgery. However, treating physicians vigilantly kept him on regular follow-up and investigated further. The patient was diagnosed to have a lesion in the lung 3 months after surgery. Thus, it was considered primary neuroendocrine carcinoma of the brain; however, regular follow-up and further positron emission tomography scan showed a small mass in the lung and adrenal gland. Based on this, a final diagnosis of metastatic neuroendocrine carcinoma of the brain was made.

Dome-shaped pituitary enlargement in primary hypothyroidism / Journal of the ASEAN Federation of Endocrine Societies

@#We describe three cases of primary hypothyroidism which presented initially to neurosurgery department with pituitary hyperplasia. We have found a novel pattern of ‘dome-shaped’ enlargement of pituitary in MRI of these patients. Out of these 3 patients, in two of them, the planned surgery was deferred when endocrinologists were consulted and the pituitary hyperplasia completely resolved with levothyroxine treatment. In the third case, pituitary surgery was already performed before endocrinology consultation and histopathology revealed thyrotroph hyperplasia. The hyperplastic lesions described typically have a homogenous symmetrical ‘dome’ shaped architecture unlike the non-functioning pituitary adenoma (NFPA), which usually might often be of varying shapes and homogeneity. Analysis of pituitary images from similar case reports published in literature, also showed this typical ‘dome’ shaped pituitary enlargement. This imaging characteristic can be a clue to look for underlying hormone deficiency, especially in primary hypothyroidism. Therefore, a thorough endocrine evaluation especially looking for primary hypothyroidism in such dome-shaped pituitary lesions are mandatory to prevent unwarranted neuro-surgical intervention as treatment of primary hypothyroidism may result in resolution of the abnormal enlargement.