Glioblastoma and prolactinoma: a rare simultaneous occurrence

Abstract

The simultaneous development of two or more primary central nervous system (CNS) tumors of different cell types represents 0.9% of all diagnosed CNS tumors. To the best of our knowledge, the simultaneous occurrence of glioblastoma and pituitary adenomas has been reported four times in the English literature, with only two cases harboring prolactinoma and glioblastoma. We report a case of a 42-year-old male who was diagnosed with a sporadic co-occurrence of glioblastoma and a prolactin-secreting pituitary adenoma (prolactinoma). This case report discusses the clinical presentation, radiological/histopathological features, and outcome as well as reviewing the pertinent medical literature. Glioblastoma and a prolactin-secreting adenoma may be detected within the same patient. Further studies are required to delineate the tumorigenesis of the development and co-occurrence of multiple intracranial tumors.

Figure 1:

Preoperative neuroimaging of the patient—CT (a and b) and MRI ((c–f )—with contrast enhancement), showing a centrally necrotic peripherally enhancing mass lesion in the left posteromedial temporal lobe representing glioblastoma. The non-enhancing component of the tumor extended to the left thalamus. Another sellar and suprasellar mass lesion representing a pituitary macroadenoma. (g–i) The MR spectroscopy shows a very low N-acetylaspartate (NAA) and high choline keeping up with a malignant tumor.

Figure 2:

(a) High power view showing hyperchromatic glial nuclei and a couple of mitoses (green arrows). (b) Microvascular proliferation (arrows). (c) (GFAP) immunostain cytoplasmic positivity confirms astrocytic lineage; notice the negatively staining microvascular proliferation. (d) Ki-67 labeling index is high.