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Pituitary metastasis: From pathology to clinical and radiological considerations

  • M.M. Kameda-Smith
    Correspondence
    Corresponding authors at: Department of Surgery, Division of Neurosurgery, Hamilton, General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada (M.M. Kameda-Smith). Pathology and Molecular Medicine, Department of Pathology and Molecular Medicine, Division of Anatomical Pathology, Neuropathology, Hamilton, General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada (J-Q. Lu).
    Affiliations
    McMaster University, Canada

    Departments of Surgery, Canada
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  • E. Zhang
    Affiliations
    McMaster University, Canada

    Diagnostic Imaging, Canada
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  • M. Lannon
    Affiliations
    McMaster University, Canada

    Departments of Surgery, Canada
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  • A. Algird
    Affiliations
    McMaster University, Canada

    Departments of Surgery, Canada
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  • K. Reddy
    Affiliations
    McMaster University, Canada

    Departments of Surgery, Canada
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  • J-Q. Lu
    Correspondence
    Corresponding authors at: Department of Surgery, Division of Neurosurgery, Hamilton, General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada (M.M. Kameda-Smith). Pathology and Molecular Medicine, Department of Pathology and Molecular Medicine, Division of Anatomical Pathology, Neuropathology, Hamilton, General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada (J-Q. Lu).
    Affiliations
    McMaster University, Canada

    Neuropathology, Canada
    Search for articles by this author

      Highlights

      • Comprehensive review of metastatic lesions to the pituitary.
      • Includes review of tumor-tumor metastasis and metastatic collision tumors.
      • Radiological insights to primary versus pituitary metastatic lesions.
      • Management of pituitary metastasis including surgical indications and adjuvant therapy.

      Abstract

      Purpose

      A review of the literature with respect to pituitary metastases (PM) with clinical and radiological considerations are summarized to facilitate clinical decision making in the management of PM

      Methods

      A review of literature associated with PM and tumour to tumour metastases in the English literature was reviewed and summarized

      Results

      Pituitary metastases account for 1.0–3.6% of all surgically treated pituitary lesions. Often identified in parallel with extensive disseminated disease, once diagnosed, the prognosis is generally poor, although survival is highly heterogeneous and dependent on the primary tumor histology. Within this anatomical region is also the observation of tumor-to-tumor metastases and collision tumours. Both the tumor macro- and microenvironment play central roles to the progression of disease with distinctive radiological features that may suggest a metastatic sellar lesion as opposed to a primary pituitary lesion. Surgical resection is the first line of therapy followed by adjuvant chemoradiotherapy and endocrinological evaluation for hormonal supplementation

      Conclusion

      PMs are relatively rare but important oncological entities representing disseminated disease in the majority of cases. Careful consideration of the relevant clinical history and radiological features can aid the clinician differentiate between a metastatic lesion to the pituitary region and a primary pituitary tumor. While surgical resection is first line therapy, stereotactic radiosurgery in carefully selected patients is emerging as a viable alternative.

      Keywords

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