Clival prolactinoma masquerading as a chordoma: a case report

Abstract

Ectopic pituitary adenomas are a rare clinical entity and are frequently mistaken for other base of skull lesions on imaging. We report the clinical presentation and management of a woman presenting with an ectopic prolactinoma located in the clivus. A 66-year-old female presented with a 6-month history of headaches and light-headedness. Anatomical imaging demonstrated a clival lesion most suspicious for chordoma. Endocrinological assessment revealed modestly increased prolactin level with lower-than-expected gonadotrophins levels for her age. Surgical resection confirmed an ectopic prolactinoma. A skull base lesion in a patient with hormonal derangement should lend to a high clinical suspicion of an EPA as they may be treated with medications before surgery. Guidelines could assist clinicians investigating skull-based lesions to identify the rare, but important diagnosis of ectopic pituitary adenomas.

Keywords: Adenoma or tumor; Chordoma; Clival; Ectopic; Pituitary.

Fig. 1

Axial (A) and sagittal (B) non-contrast CT of the skull base demonstrates a lytic lesion within the cloves (arrow). The sella (*) is not expanded but does have some focal areas of bone erosion along the floor.

Fig. 2

MRI of the brain and skull base. Axial T2 (A) and coronal T2 (B) sequences show a hyperintense lesion within the cloves (arrows). The normal pituitary tissue is seen above but in close proximity to the lesion (short arrow). On the coronal T1 with contrast sequence (C), the lesion shows heterogenous internal enhancement (arrow).

Fig. 3

Post-operative MRI of the skull base. Axial T2 (A) and axial T1 with contrast (B) sequences demonstrate resection of the lesion, with non-enhancing, T2 hyperintense post-surgical change within the clivus (arrows).