LOTO MG, ROGOZINSKI A*, ALFIERI A, BALLARINO, MC, BATTISTONE MF, CHERVIN A, DANILOWICZ K, DIEZ S, FAINSTEIN DAY P, FURIOSO A, GLEREAN M, GONZALEZ PERNAS M, KATZ D, MALLEA GIL MS, MARTINEZ.M, MIRAGAYA K, SABATE MI, SLAVINSKY P, SOSA S, SZUMAN G, TKATCH J, VITALE N, GUITELMAN M
La región selar es un sitio infrecuente de metástasis, pudiendo encontrarse en 1% de las cirugías hipofisarias. Los tumores primarios más habituales son mama y pulmón. En general son diagnosticadas en pacientes con enfermedad avanzada, aunque pueden ser el debut de la enfermedad oncológica. El objetivo fue analizar las características clínicas, bioquímicas, radiológicas de 17 pacientes con metástasis selares (MS), 10 con confirmación histológica de la metástasis selar (MS), y 7 en quienes el diagnóstico se definió por la presencia de masa selar asociada a manifestaciones clínicas o radiológicas, en pacientes con enfermedad oncológica conocida. La mediana (m) de edad fue 53 años (35-70), siendo 53% mujeres. La localización del tumor primario fue: 8 pulmón, 5 mama, 1 carcinoma folicular de tiroides, 1 linfoma Hodgkin y 2 carcinomas renales de células claras. La m de tiempo entre el diagnóstico del primario y la aparición de la MS fue 48 meses (11-120). Diabetes insípida, déficit anterohipofisario, trastornos visuales, y oftalmoplejía se presentaron en el 82%, 78%, 59%, y 35 %, respectivamente. Catorce pacientes presentaron masas con extensión supra/paraselar; y 3 lesión limitada a la hipófisis, con engrosamiento de tallo y desaparición de la hiperintensidad de neurohipófisis en 2. Todos evidenciaron captación difusa del gadolinio. Fueron operados 10/17 pacientes por vía transesfenoidal, para diagnóstico y/ o descompresión. Todos los pacientes fallecieron con una mediana de sobrevida de 6 meses (1-36). Las neoplasias primarias más frecuentes fueron mama y pulmón. La diabetes insípida y el hipopituitarismo anterior fueron las manifestaciones más frecuentes, seguidos por disfunción visual. En la mitad de los casos el diagnóstico del cáncer se hizo a partir de la lesión selar. La sospecha de MS debe estar presente ante una masa selar y supraselar con captación difusa del gadolinio, diabetes insípida, hipopituitarismo y/o disfunción visual, aun en pacientes sin antecedentes oncológicos.
Sellar Metastases (SM) are rare manifestations of malignancy. Breast and lung cancer are the most common primary tumors. Most cases are diagnosed in patients with advanced malignant disease, between the sixth and seventh decades of life; however, symptoms of pituitary involvement can precede the diagnosis of the primary tumor. The objectives were to evaluate symptoms at presentation, hormonal, radiological and histological findings, management, and outcome of a series of patients with SM. Medical records of 17 patients from different hospitals of Buenos Aires were reviewed. Ten patients had histological confirmation of the pituitary MTS, 7 were not operated on, being the diagnostic criteria sellar mass associated with clinical manifestations (insipidus diabetes, visual dysfunction and panhypopituitarism) or radiological findings suggestive of metastatic infiltration, in patients with confirmed primary neoplasia. Median (m) age was 53 years (range 35-70), 53% women. Primary malignant tumors were: 8 lung (47,5%), 5 breast (29%), 1 follicular thyroid carcinoma, 1 Hodgkin lymphoma, and 2 clear cell renal carcinoma. The m time between the diagnosis of the primary neoplasm and the occurrence of the pituitary MTS was 48 months (range: 11-120). In 8 patients (47%), the diagnosis of the primary neoplasm was made after the finding of the symptomatic sellar mass. Diabetes Insipidus, adenohypophyseal deficit, visual disorders, headache, and cranial nerve deficits were presented in 82%, 78%, 59%, 41% and 35 % of the cases respectively. In 13/17 (76,5%) other MTS were detected. Sixteen patients were evaluated by MRI and one by CT: Fourteen harbored supra / parasellar masses, in three a lesion was limited to the pituitary gland, and stalk thickening and disappearance of spontaneous neurohypophysis hyperintensity in two of them. In all cases, diffuse gadolinium uptake was present. Ten out of 17 (58.82%) of the patients were operated on by the transsphenoidal route, for diagnostic and / or decompressive purposes. All patients died, with a m survival time of 6,5 months (range: 1-36). In this series of 17 patients with pituitary MTS, the most frequent primary neoplasms were lung and breast. DI was the most common condition at presentation, followed by hypopituitarism and visual disorders. In a half of the cases the diagnosis of primary neoplasia was made through the symptomatic pituitary mass. In the presence of a pituitary lesion with diffuse gadolinium uptake, associated with DI and / or visual disfunction, pituitary MTS should be suspected even in patients without a history of oncological disease.