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Case Reports
. 2019 Jan 10:2019:9769657.
doi: 10.1155/2019/9769657. eCollection 2019.

Sellar Metastasis of Cervical Adenocarcinoma

Krishnan Ravindran  1 , Brandon M Zsigray  1 , Michael P Wemhoff  1 , John D Spencer  1 , Ewa Borys  2 , Chirag R Patel  3 , Anand V Germanwala  1   3
Affiliations
Case Reports

Sellar Metastasis of Cervical Adenocarcinoma

Krishnan Ravindran et al. Case Rep Neurol Med. .

Abstract

Background: Pituitary metastasis of cervical adenocarcinoma is an exceedingly rare phenomenon.

Case description: The authors present a case of a 66-year-old female with cervical adenocarcinoma who was discovered to have a rapidly growing intrasellar mass in the work-up of adrenal insufficiency and hypothyroidism. The patient underwent subsequent endoscopic endonasal subtotal resection of the mass. Histopathological analysis of the resected lesion demonstrated features consistent with metastatic mucinous adenocarcinoma of the cervix. While initially neurologically asymptomatic following surgery, the patient developed an oculomotor nerve palsy several weeks following surgical debulking, at which time neuroimaging revealed marked regrowth and suprasellar extension of the metastatic lesion.

Conclusions: While metastatic cervical adenocarcinoma to the sella is rare, it should be considered in the differential based on the history of the patient.

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Figures

Figure 1
Figure 1
Preoperative sagittal MRI with contrast demonstrating the homogenously contrast enhancing sellar/suprasellar mass with mass effect on the optic chiasm.
Figure 2
Figure 2
Immediately postoperative sagittal MRI with contrast showing subtotal resection through an endoscopic endonasal approach.
Figure 3
Figure 3
(a) Frozen section tissue showing interface between mucinous adenocarcinoma metastasis and adjacent adenohypophysis (arrow), H&E, 40x. (b) Metastatic mucinous adenocarcinoma showing clusters of moderately pleomorphic epithelial cells floating in pools of mucin separated by fibrovascular septae of variable thickness, H&E, 200x. (c) Cytokeratin CK8/18 is positive in tumor cells; immunohistochemical stain, 200x. (d) p16 shows nuclear positivity; immunohistochemical stain, 200x.
Figure 4
Figure 4
(a, b) Cervical biopsy showing a moderately differentiated mucinous/colloid adenocarcinoma. H&E, 40x (a) and 200x (b).
Figure 5
Figure 5
Postoperative sagittal MRI with contrast five weeks after surgery showing significant tumor recurrence.
See this image and copyright information in PMC

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