Xu L, Khaddour K, Chen J, Rich KM, Perrin RJ, Campian JL. Pituitary carcinoma: Two case reports and review of literature. World J Clin Oncol 2020; 11(2): 91-102 [PMID: 32133278 DOI: 10.5306/wjco.v11.i2.91]
Corresponding Author of This Article
Jian Li Campian, MD, PhD, Assistant Professor, Divisions of Hematology and Oncology, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, Box 8056, St. Louis, MO 63110, United States. campian.jian@wustl.edu
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Feb 24, 2020; 11(2): 91-102 Published online Feb 24, 2020. doi: 10.5306/wjco.v11.i2.91
Pituitary carcinoma: Two case reports and review of literature
Lai Xu, Karam Khaddour, Jie Chen, Keith M Rich, Richard J Perrin, Jian Li Campian
Lai Xu, Karam Khaddour, Jian Li Campian, Divisions of Hematology and Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, United States
Jie Chen, Richard J Perrin, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, United States
Keith M Rich, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, United States
Author contributions: Xu L and Khaddour K contributed equally and performed the chart, literature review, and wrote the manuscript in consultation with other authors; Chen J prepared Figures 2 and 4; Rich KM operated on both cases, and contributed to the surgery session; Perrin RJ performed the histopathologic examination, and provided critical feedback on interpreting and communicating the pathology results in the manuscript; Campian JL supervised the entire work; all authors contributed to the final version of the manuscript.
Informed consent statement: An informed consent statement was obtained and provided to the journal editorial office. Patients’ identifiers were omitted from the original manuscript.
Conflict-of-interest statement: Campian JL reports research support from NeoImmuneTech Inc. and Incyte Corporation, outside the submitted work. The remaining authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian Li Campian, MD, PhD, Assistant Professor, Divisions of Hematology and Oncology, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, Box 8056, St. Louis, MO 63110, United States. campian.jian@wustl.edu
Received: August 23, 2019 Peer-review started: August 23, 2019 First decision: September 2, 2019 Revised: October 1, 2019 Accepted: December 13, 2019 Article in press: December 13, 2019 Published online: February 24, 2020 Processing time: 185 Days and 2.1 Hours
Abstract
BACKGROUND
Pituitary carcinoma is a rare type of malignancy that can be very difficult to diagnose and treat. Many cases were diagnosed at autopsy. Delays in diagnosis often adversely impact patients' outcomes. Even with prompt diagnosis, treatment decisions remain challenging in the absence of randomized controlled trials.
CASE SUMMARY
We report two cases of pituitary carcinoma in men with a history of pituitary adenoma. In the first case, a 55-year-old man was initially diagnosed with pituitary macroadenoma. He underwent subtotal debulking of the tumor followed by adjuvant radiotherapy. Subsequently, he developed relapsed disease and multifocal intracranial metastases and a diagnosis of pituitary carcinoma was rendered. He passed away despite several lines of systemic therapies including temozolomide, lomustine and bevacizumab. Another 52-year-old man was diagnosed with atypical pituitary adenoma with presentation of sudden onset of vision loss in the right eye. He had recurrent pituitary carcinoma with spinal metastases, treated with surgery, radiation and temozolomide.
CONCLUSION
Pituitary carcinoma is a rare neoplasm with poor prognosis that is difficult to diagnose and treat. The small number of cases restricts our ability to design randomized clinical trials. Management is largely driven by retrospective studies and case series. Establishing molecular biomarkers and comprehensive genomic profiling could help in decisions about diagnosis and management of pituitary carcinoma.
Core tip: Pituitary carcinoma is a rare type of malignancy that can be very difficult to diagnose and treat. Many cases were diagnosed at autopsy. Delays in diagnosis often adversely impact patients' outcomes. Even with prompt diagnosis, treatment decisions remain challenging in the absence of randomized controlled trials. Establishing molecular biomarkers and comprehensive genomic profiling could help in decisions about diagnosis and management of pituitary carcinoma.
