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A case of nonfunctioning pituitary carcinoma that responded to temozolomide treatment.

Morokuma H, Ando T, Hayashida T, Horie I, Inoshita N, Murata F, Ueki I, Nakamura K, Imaizumi M, Usa T, Kawakami A - Case Rep Endocrinol (2012)

Bottom Line: The patient received continuous dosing of TMZ along with external radiation, followed by standard dosing of TMZ.There was an apparent antitumor response seen in MRI.MGMT, an enzyme antagonized by TMZ, was negative in the tumor.

View Article: PubMed Central - PubMed

Affiliation: First Department of Medicine, Nagasaki University Graduates School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.

ABSTRACT
Pituitary carcinoma is a rare malignancy and is difficult to manage. Pituitary carcinomas commonly produce either PRL or ACTH, but some do not produce pituitary hormones. The alkylating reagent temozolomide (TMZ) was recently shown to be effective as a treatment for pituitary carcinoma. Most of the published reports of TMZ use in pituitary carcinoma cases were against hormone-producing carcinomas. Only a few patients with a nonfunctioning pituitary carcinoma treated with TMZ have been reported. Here we describe our treatment of a patient with nonfunctioning pituitary carcinoma and a background of multiple endocrine neoplasia type 1. The pituitary carcinoma was accompanied by meningeal dissemination with cerebral and L1 spinal bone metastasis. The patient received continuous dosing of TMZ along with external radiation, followed by standard dosing of TMZ. There was an apparent antitumor response seen in MRI. MGMT, an enzyme antagonized by TMZ, was negative in the tumor. The therapeutic efficacy of TMZ and dosing schedules of TMZ in pituitary carcinoma are discussed.

No MeSH data available.


Related in: MedlinePlus

Pituitary carcinoma before the treatment. The pituitary tumor surrounds the bilateral cavernous sinus and protrudes close to the optic chiasm (detected by contrast-enhanced MRI). The tumor invades the left temporal lobe (a). Metastatic brain tumor in the occipital lobe shows ringlike enhancement (b). The pituitary tumor shows meningeal dissemination (c). Metastatic tumor in the L1 and diffuse meningeal dissemination (d).
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fig1: Pituitary carcinoma before the treatment. The pituitary tumor surrounds the bilateral cavernous sinus and protrudes close to the optic chiasm (detected by contrast-enhanced MRI). The tumor invades the left temporal lobe (a). Metastatic brain tumor in the occipital lobe shows ringlike enhancement (b). The pituitary tumor shows meningeal dissemination (c). Metastatic tumor in the L1 and diffuse meningeal dissemination (d).

Mentions: Because of the patient's past history of pituitary tumor and present primary hyperparathyroidism, the patient was suspected to be a sporadic case of multiple endocrine neoplasia (MEN) type 1. To test this, a systemic survey was performed. First, a large pituitary tumor with a diffuse meningeal dissemination with multiple metastatic tumors in the brain and the L1 spine (Figure 1) was found. A lumbar punctuation to obtain cytology specimens was not performed because of the potential risk of the brain herniation. Secondly, a neck tumor with a marked accumulation of MIBI (not shown) was identified. Finally, multiple pancreatic tumors with increased vascularity, compatible with a neuroendocrine tumor (not shown) were identified. No other tumors were detected, and therefore the patient was clinically diagnosed as a sporadic case of MEN type 1 with a clinically nonfunctioning pituitary carcinoma, a parathyroid tumor, and pancreatic neuroendocrine tumors. Genomic analysis failed to identify mutation(s) in menin exons (data not shown).


A case of nonfunctioning pituitary carcinoma that responded to temozolomide treatment.

Morokuma H, Ando T, Hayashida T, Horie I, Inoshita N, Murata F, Ueki I, Nakamura K, Imaizumi M, Usa T, Kawakami A - Case Rep Endocrinol (2012)

Pituitary carcinoma before the treatment. The pituitary tumor surrounds the bilateral cavernous sinus and protrudes close to the optic chiasm (detected by contrast-enhanced MRI). The tumor invades the left temporal lobe (a). Metastatic brain tumor in the occipital lobe shows ringlike enhancement (b). The pituitary tumor shows meningeal dissemination (c). Metastatic tumor in the L1 and diffuse meningeal dissemination (d).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472534&req=5

fig1: Pituitary carcinoma before the treatment. The pituitary tumor surrounds the bilateral cavernous sinus and protrudes close to the optic chiasm (detected by contrast-enhanced MRI). The tumor invades the left temporal lobe (a). Metastatic brain tumor in the occipital lobe shows ringlike enhancement (b). The pituitary tumor shows meningeal dissemination (c). Metastatic tumor in the L1 and diffuse meningeal dissemination (d).
Mentions: Because of the patient's past history of pituitary tumor and present primary hyperparathyroidism, the patient was suspected to be a sporadic case of multiple endocrine neoplasia (MEN) type 1. To test this, a systemic survey was performed. First, a large pituitary tumor with a diffuse meningeal dissemination with multiple metastatic tumors in the brain and the L1 spine (Figure 1) was found. A lumbar punctuation to obtain cytology specimens was not performed because of the potential risk of the brain herniation. Secondly, a neck tumor with a marked accumulation of MIBI (not shown) was identified. Finally, multiple pancreatic tumors with increased vascularity, compatible with a neuroendocrine tumor (not shown) were identified. No other tumors were detected, and therefore the patient was clinically diagnosed as a sporadic case of MEN type 1 with a clinically nonfunctioning pituitary carcinoma, a parathyroid tumor, and pancreatic neuroendocrine tumors. Genomic analysis failed to identify mutation(s) in menin exons (data not shown).

Bottom Line: The patient received continuous dosing of TMZ along with external radiation, followed by standard dosing of TMZ.There was an apparent antitumor response seen in MRI.MGMT, an enzyme antagonized by TMZ, was negative in the tumor.

View Article: PubMed Central - PubMed

Affiliation: First Department of Medicine, Nagasaki University Graduates School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.

ABSTRACT
Pituitary carcinoma is a rare malignancy and is difficult to manage. Pituitary carcinomas commonly produce either PRL or ACTH, but some do not produce pituitary hormones. The alkylating reagent temozolomide (TMZ) was recently shown to be effective as a treatment for pituitary carcinoma. Most of the published reports of TMZ use in pituitary carcinoma cases were against hormone-producing carcinomas. Only a few patients with a nonfunctioning pituitary carcinoma treated with TMZ have been reported. Here we describe our treatment of a patient with nonfunctioning pituitary carcinoma and a background of multiple endocrine neoplasia type 1. The pituitary carcinoma was accompanied by meningeal dissemination with cerebral and L1 spinal bone metastasis. The patient received continuous dosing of TMZ along with external radiation, followed by standard dosing of TMZ. There was an apparent antitumor response seen in MRI. MGMT, an enzyme antagonized by TMZ, was negative in the tumor. The therapeutic efficacy of TMZ and dosing schedules of TMZ in pituitary carcinoma are discussed.

No MeSH data available.


Related in: MedlinePlus