Concurrent Metastatic Pulmonary Neuroendocrine Tumor and Pituitary Macroadenoma
Introduction: The coexistence of a sellar mass in a patient with a neuroendocrine tumor, while rare, can paint the clinical picture of either a genetic syndrome, most notably multiple endocrine neoplasia syndrome type 1(MEN1) or pituitary metastasis recently more frequent probably due to the longer survival of cancer patients.
Aim(s): We report the case of a 71-year-old woman referred for apathy, visual impairment and persistent headache. Her personal history revealed an atypical lung carcinoid, for which curative surgery was performed in 2012.
Materials and methods: Physical examination showed anisocoria, right ophthalmoplegia and blepharoptosis. Lab tests were suggestive of panhypopituitarism for which substitution treatment was promptly introduced. Cg A was more than 10 times the upper limit of normal, which raised the suspicion of recurrent or metastatic disease. Biochemical screening for MEN1 was negative. Pituitary MRI described a Knosp grade 4 tumor for which debulking surgery was performed and pathologically and immunohistochemically diagnosed as a non-functioning pituitary adenoma with high proliferative activity (Ki 67=26%). Abdominal MRI showed a hepatic macronodular lesion which was completely resected and diagnosed as a high grade (G3) neuroendocrine tumor metastasis.
Conference: 17th Annual ENETSConcerence (2020)
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