Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Jan 4:12:1059361.
doi: 10.3389/fonc.2022.1059361. eCollection 2022.

Case Report: Pituitary metastasis as a presenting manifestation of silent gastric cardia adenocarcinoma

Andrea Ghezzi  1 , Jessica Rossi  2   3 , Francesco Cavallieri  3 , Manuela Napoli  4 , Rosario Pascarella  4 , Romana Rizzi  3 , Marco Russo  3 , Gaetano Salomone  3 , Antonio Romano  5 , Corrado Iaccarino  5 , Elisabetta Froio  6 , Silvia Serra  6 , Salvatore Cozzi  7 , Lucia Giaccherini  7 , Franco Valzania  3 , Anna Pisanello  3
Affiliations
Case Reports

Case Report: Pituitary metastasis as a presenting manifestation of silent gastric cardia adenocarcinoma

Andrea Ghezzi et al. Front Oncol. .

Abstract

Introduction: Pituitary metastases are very rare in cancer patients and often originate from lung or breast tumors. They usually occur in patients with known metastatic disease, but rarely may be the first presentation of the primary tumor.

Methods: We present the case of a 58 years-old-man who reported a three-month history of polyuria-polydipsia syndrome, generalized asthenia, panhypopituitarism and bitemporal hemianopsia. Brain-MRI showed a voluminous pituitary mass causing posterior sellar enlargement and compression of the surrounding structures including pituitary stalk, optic chiasm, and optic nerves.

Results: The patient underwent neurosurgical removal of the mass. Histological examination revealed a poorly differentiated adenocarcinoma of uncertain origin. A total body CT scan showed a mass in the left kidney that was subsequently removed. Histological features were consistent with a clear cell carcinoma. However, endoscopic examination of the digestive tract revealed an ulcerating and infiltrating adenocarcinoma of the gastric cardia. Total body PET/CT scan with 18F-FDG confirmed an isolated area of accumulation in the gastric cardia, with no hyperaccumulation at other sites.

Conclusion: To the best of our knowledge, there are no reports of pituitary metastases from gastric cardia adenocarcinoma. Our patient presented with symptoms of sellar involvement and without evidence of other body metastases. Therefore, sudden onset of diabetes insipidus and visual deterioration should lead to the suspicion of a rapidly growing pituitary mass, which may be the presenting manifestation of a primary extracranial adenocarcinoma. Histological investigation of the pituitary mass can guide the diagnostic workup, which must however be complete.

Keywords: diabetes insipidus - neurogenic/central; gastroesophageal junction adenocarcinoma; hypopituitarism; pituitary metastasis; visual disturbance.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
First MRI-scan. Sagittal T2-weighted (A) and post-contrast T1-weighted (B) images. Sellar and suprasellar mass involving posterior lobe and infundibulum of the pituitary gland, with low signal on T2-images. Compression of mammillary body, optic chiasm and tracts, third ventricle (infundibular recess).
Figure 2
Figure 2
Histopathological examination of the sellar mass, consistent with a pituitary localization of an Adenocarcinoma, showing a pseudopapillary and glandular architectural pattern with necrosis and brisk mitotic activity (EE 20x). Insert: Immunostaining for CDX2 (20x).
Figure 3
Figure 3
One-month follow-up MRI scan. Sagittal T2-weighted (A) and post-contrast T1-weighted (B) images. Post-surgical sellar modification with increase of the residual tumor in suprasellar spaces, third ventricle invasion and mammillary body compression and infiltration.
Figure 4
Figure 4
Follow-up MRI scan at 139 days. Sagittal T2-Weighted (A) and post-contrast T1-weighted (B) images. Post-surgical sellar modification with small residual tumor in suprasellar/infundibular region. Axial post-contrast T1-weighted images (C-F): multifocal leptomeningeal dissemination (arrows).
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Kameda-Smith MM, Zhang E, Lannon M, Algird A, Reddy K, Lu JQ. Pituitary metastasis: From pathology to clinical and radiological considerations. J Clin Neurosci (2021) 93:231–40. doi: 10.1016/j.jocn.2021.09.016 - DOI - PubMed
    1. Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg (1998) 85(11):1457–9. doi: 10.1046/j.1365-2168.1998.00940.x - DOI - PubMed
    1. Bornschein J, Quante M, Jansen M. The complexity of cancer origins at the gastro-oesophageal junction. Best Pract Res Clin Gastroenterol (2021) 50-51:101729. doi: 10.1016/j.bpg.2021.101729 - DOI - PubMed
    1. He W, Chen F, Dalm B, Kirby PA, Greenlee JD. Metastatic involvement of the pituitary gland: a systematic review with pooled individual patient data analysis. Pituitary. (2015) 18(1):159–68. doi: 10.1007/s11102-014-0552-2 - DOI - PubMed
    1. van Vliet EP, Steyerberg EW, Eijkemans MJ, Kuipers EJ, Siersema PD. Detection of distant metastases in patients with oesophageal or gastric cardia cancer: a diagnostic decision analysis. Br J Cancer. (2007) 97(7):868–76. doi: 10.1038/sj.bjc.6603960 - DOI - PMC - PubMed

Publication types

LinkOut - more resources