Preferential sites of metastatic relapse on MRI of initially localized ependymoma in children.

OBJECTIVE: Relapse of ependymoma in childhood portends a grave prognosis. While the detection of local recurrence is usually simple, spotting leptomeningeal metastasis might be challenging. We aimed to evaluate possible "hotspots" where metastasis tend to appear. MATERIALS AND METHODS: Medical records and Magnetic Resonance (MR) studies of all patients diagnosed with brain ependymomas between the years 2000-2015 were reviewed. RESULTS: Leptomeningeal spread was detected among 42% of relapsed patients. The most common sites were spine and hypothalamic area (26% each). CONCLUSION: A meticulous assessment of the brain and spine including a thorough evaluation of the hypothalamic area is recommended.

[Metastasis from breast cancer to the pituitary gland causing hyponatriaemia].

Breast cancer is the most common cancer in Danish women. Pituitary metastases are rare events. We report a 75-year-old woman with metastatic breast cancer who presented with pituitary insufficiency nine years after her initial cancer diagnosis. MRI of the pituitary region showed a parasellar mass and thickening of the infundibulum. Her condition progressed within months and deterioration of visual field and acuity developed. A transsphenoidal resection was performed to rescue her vision and pathology confirmed metastasis from a breast invasive ductal adenocarcinoma.

Impaired aerobic exercise adaptation in children and adolescents with craniopharyngioma is associated with hypothalamic involvement.

OBJECTIVE: Many patients treated for craniopharyngioma (CP) complain of a relative incapacity for physical activity. Whether this is due to an objective decrease in adaptation to exercise is unclear. We assessed exercise tolerance in children with surgically treated CP and appropriate pituitary hormone replacement therapy compared with healthy controls and we examined the potential relationships with hypothalamic involvement, GH replacement, and the catecholamine deficiency frequently observed in these subjects. DESIGN AND METHODS: Seventeen subjects (12 males and five females) with CP and 22 healthy controls (14 males and eight females) aged 15.3±2.5 years (7.3-18 years) underwent a standardized cycle ergometer test. Maximum aerobic capacity was expressed as the ratio of VO(2max) to fat-free mass (VO(2max)/FFM), a measure independent of age and fat mass in children. RESULTS: VO(2max)/FFM was 20% lower in children with CP compared with controls (P<0.05), even after adjustment for gender. Children with hypothalamic involvement (n=10) had a higher percentage of fat mass (P<0.05) than those without hypothalamic involvement (n=7) and lower VO(2max)/FFM (P<0.05), whereas children without hypothalamic involvement had VO(2max)/FFM close to that of controls (P>0.05). GH treatment was associated with a significant positive effect on aerobic capacity (P<0.05) only in the absence of hypothalamic involvement. No relationship was found between exercise capacity parameters and daily urine epinephrine excretion or epinephrine peak response to insulin-induced hypoglycemia. CONCLUSIONS: Children with CP have a decrease in aerobic capacity mainly related to hypothalamic involvement. The hypothalamic factors altering aerobic capacity remain to be determined.

Panhypopituitarism due to metastases to the hypothalamus and the pituitary resulting from primary breast cancer: a case report and review of the literature.

Pituitary metastasis occurs rarely in cancer patients and often remains undiagnosed. However, early detection and appropriate treatment can improve the patient's quality of life and possibly prolong survival. Herein, we describe the case of a 52-year-old woman with panhypopituitarism caused by metastases to the hypothalamus and pituitary from primary breast cancer. She had a 5-year history of breast cancer with metastases to the bones 1.5 years after initial diagnosis and mastectomy. She presented with severe headaches, generalized fatigue, dizziness, hypotension, difficulties with balance and coordination, polyuria, and polydipsia. Laboratory work-up revealed panhypopituitarism (central diabetes insipidus; hypothyroidism; and low prolactin, gonadotrophin, and adrenocorticotropic hormone levels), and magnetic resonance imaging confirmed the pituitary and hypothalamic involvement. She received hormone replacement therapy, radiation therapy of the sella turcica and suprasellar lesion, and chemotherapy, with significant improvement of her clinical status, but she died 15 months later.

[Secondary hypopituitarism due to hypothalamic metastasis from small cell lung cancer]. / Hipopituitarismo secundario debido a metástasis en región hipotalámica de carcinoma microcítico de pulmón.

Parasellar and hypothalamic metastases are uncommon. Their principal clinical manifestation is diabetes insipidus. Associated hypopituitarism is very rare. We report the case of a 54-year-old man with small cell lung cancer and hypopituitarism. A brain magnetic resonance imaging scan revealed a mass in the anterior region of the third ventricle with no clear etiology. The patient began chemotherapy treatment and the mass disappeared, which confirmed the diagnosis of secondary hypopituitarism caused by hypothalamic metastasis from small cell lung cancer.

Hipopituitarismo secundario debido a metástasis en región hipotalámica de carcinoma microcítico de pulmón / Secondary hypopituitarism caused by hypothalamic metastasis from small cell lung cancer

Las metástasis en la región selar e hipotalámica son raras y la principal manifestación clínica es la diabetes insípida. Un hipopituitarismo concomitante se produce en muy pocas ocasiones. Presentamos el caso de un varón de 54 años con carcinoma microcítico de pulmón e hipopituitarismo. Una resonancia magnética cerebral reveló una lesión en la cara anterior del tercer ventrículo sin etiología clara. El paciente inició tratamiento con quimioterapia y la lesión desapareció. Por lo tanto, el paciente fue diagnosticado de hipopitituarismo secundario a metástasis hipotalámica de carcinoma microcítico de pulmón (AU)

Parasellar and hypothalamic metastases are uncommon. Their principal clinical manifestation is diabetes insipidus. Associated hypopituitarism is very rare. We report the case of a 54-year-old man with small cell lung cancer and hypopituitarism. A brain magnetic resonance imaging scan revealed a mass in the anterior region of the third ventricle with no clear etiology. The patient began chemotherapy treatment and the mass disappeared, which confirmed the diagnosis of secondary hypopituitarism caused by hypothalamic metastasis from small cell lung cancer (AU)

Intracranial retrograde dissemination in filum terminale myxopapillary ependymomas.

Myxopapillary ependymomas (ME) are considered benign tumours (WHO grade I) of the central nervous system with long term survival rates and a tendency to local recurrence. However an aggressive course has occasionally been described, leading to CSF dissemination and even systemic metastases. We describe the case of a 23-year-old man diagnosed with intracranial subarachnoid dissemination of a filum terminale ME three years after the initial diagnosis. We have performed a careful review of the literature on CSF dissemination in ME and finally propose treatment of these cases.

Molecular diagnosis of a BRAF papillary thyroid carcinoma with multiple chromosome abnormalities and rare adrenal and hypothalamic metastases.

OBJECTIVE: Molecular characterization of thyroid tumors is rarely applied to patient management. Our aim was to demonstrate the application of molecular and cell biology to patient care. DESIGN: Clinical and molecular case study. MAIN OUTCOMES: A 57-year-old man with papillary thyroid carcinoma presented with adrenal and several other presumed metastases, pulmonary nodules, and mediastinal lymphadenopathy. Bronchial carcinoma was entertained for the pulmonary lesions because of a tobacco history. Mediastinal lymph node biopsy was nondiagnostic. Cells from the biopsy were grown in tissue culture and characterized by immunocytochemical (ICC), allele-specific polymerase chain reaction (PCR), reverse transcription (RT)-PCR, DNA sequencing, and cytogenetics. A panel of agents were tested the cells for tumoricidal activity. The cells expressed thyroid-specific markers [thyroid-stimulating hormone receptor (TSH-R), thyroglobulin (TG), sodium iodide symporter (NIS)] and markers [thyroid transcription factor-1 (TTF-1), cytokeratin-7, epidermal growth factor receptor (EGF-R)] present in the primary tumor and adrenal metastasis. The BRAF V600E mutation was detected. The karyotype was 44-48,XY, + der(1) t(1;9)(p13;p13),add(9)(p13),-17,-18, + 0-3mar[cp20]. Lovastatin, gefitinib, paclitaxel, depsipeptide, and 17-AAG inhibited the growth of the cultured cells. Combinations of two or three drugs produced additive or synergistic effects depending upon the combination. CONCLUSIONS: Unusual metastases may be associated with multiple molecular and cytogenetic abnormalities. Thus, molecular and cell-biological studies can allow otherwise difficult thyroid tumor diagnosis and may be used for targeted, individualized selection of potential treatments.

[Hypopituitarism caused by hypothalamic metastasis of lung cancer].

A 40-year-old man was admitted due to thirst, general malaise, and swollen cervical lymph nodes. Cervical lymph node biopsy revealed moderately differentiated adenocarcinoma, and he was diagnosed lung cancer with hypothalamic metastasis. We gave him chemotherapy and hypothalamic irradiation. He had mild hydrodipsia at the first examination, which progressively worsened. He was given a diagnosis of diabetes insipidus caused by hypothalamic metastasis. We gave him desmopressin acetate, and his symptom improved. Predonisolone was prescribed, because of low levels of adrenocorticotropic hormone in the blood. After chemotherapy and irradiation of hypothalamus, metastatic focus diminished and desmopressin acetate was tapered. Hypopituitarism caused by hypothalamic metastasis is rare.

Central nervous system metastasis of a cutaneous epitheliotropic lymphosarcoma in a dog.

This report describes an uncommon case of a cutaneous epitheliotropic T-cell lymphosarcoma with central nervous system (CNS) manifestations in a 9-year-old mixed breed German shepherd dog. The animal had a history of sudden blindness, pyrexia and multifocal areas of hyperaemia in the oral mucosa. A biopsy from the muco-cutaneous junction of the lips led to the diagnosis of an epitheliotropic lymphosarcoma and the animal was humanely destroyed. At necropsy, hyperaemia in the oral mucosa was no longer detectable. In the brain, a mass effacing the optic chiasm and invading the hypothalamic area was found; histological examination revealed lymphoid tumour cell infiltration. In the epithelium of the oral mucosa, intra-epithelial lymphoid tumour cells, sometimes arranged in small clusters (Pautrier's microabscesses), in combination with a mild inflammation in the superficial dermis were observed. Skin and brain tumour cells expressed CD3 antigen, indicating their T-cell origin. This is, to our knowledge, the first report of a cutaneous epitheliotropic lymphosarcoma with CNS metastasis in a dog.

Adrenal failure due to metastasis both to the hypothalamic-pituitary area and the adrenals.

A 61-year-old white male was admitted to our hospital with a big-cell bronchogenic carcinoma whose first clinical manifestation was diabetes insipidus (DI) secondary to metastasis to the hypothalamic-pituitary area (MHP). In three months, and progressively, he developed anterior pituitary failure, as well as primary adrenal insufficiency (PAI) due to metastasis in both adrenals. Panhypopituitarism or PAI due to both MHP and adrenals has been rarely reported in the literature. A thorough examination of the oncologic patient led us to diagnose hormone insufficiency properly. The absence of reported cases might be due to the fact that the symptoms resulting from hormone insufficiency are veiled by the severe condition of the patients suffering from disseminated cancer.

[Diabetes insipidus caused by metastasis to the hypothalamo-hypophyseal axis. Apropos of 4 cases]. / Diabète insipide par métastase de l'axe hypothalamo-hypophysaire. A propos de 4 cas.

This study concerns the cases of 4 patients with polyuria and polydipsia syndrome as part of a known evolutive neoplasia. MRI demonstrated an intra- and supersellar tumoral process developed from the pituitary stalk and the posterior pituitary lobe suggesting metastasis.

Rare case with metastatic involvement of hypothalamo-pituitary and pineal body presenting as hypopituitarism and diabetes insipidus.

An unusual case with metastatic spread of a small oat cell lung carcinoma to the hypothalamo-pituitary region and pineal body presenting as pituitary insufficiency is reported. Computed tomographic scan revealed an isodense mass in the hypothalamo-pituitary region and pineal body that was strongly enhanced by contrast medium. Magnetic resonance imaging demonstrated a downward displacement of the posterior lobe of the pituitary by the hypothalamo-pituitary mass. Dynamic assessment of hypothalamo-pituitary function showed hypopituitarism and diabetes insipidus; partial recovery was observed with the improvement in the carcinoma by chemotherapy. The brain was subsequently irradiated. The patient survived 10 months.

[A case of small cell lung cancer associated with diabetes insipidus and Cushing's syndrome].

A 62-year-old male with small cell lung cancer (SCLC) associated with Cushing's syndrome and diabetes insipidus (DI) is reported. The patient was referred to our hospital for treatment of SCLC. A diagnosis of paraneoplastic Cushing's syndrome was made on the basis of an elevated serum ACTH (623.5 pg/ml) level, elevated excretion of urinary 17-OHCS (18.01 mg/day), obesity, hypertension, hyperglycemia, persistent hypokalemia, alkalosis, and no history of diabetes mellitus. He was also diagnosed as having DI based on polyuria and polydipsia, low specific gravity of the urine (1.007-1.010), low serum ADH (1.4 pg/ml) level, normal plasma osmolarity (29 mOsm/kg H2O), and the results of water deprivation test. DI and a left visual field defect was suggestive of metastasis to the pituitary region, but no lesion was detected by either CT scan or MRI scan. The patient failed to show a good response to intensive chemotherapy, and died of the tumor five months after commencing chemotherapy. Post-mortem examination revealed metastases to the hypothalamic-neurohypophyseal region, lungs, liver, adrenal glands, bone, bone marrow, and hilar and mediastinal lymph nodes.