Intraoperative cytologic diagnosis of symptomatic carcinoma (pulmonary smallcell carcinoma) metastatic to the pituitary gland:a case report
BACKGROUND: Carcinoma metastatic to the pituitary gland is infrequent and hasbeen reportedly detected in approximately 1% of pituitary surgical cases. It may masquerade as apituitary adenoma both clinically and radiologically. CASE: A 49-year-old man presented with a1-month history of severe headache, diplopia and blurred vision. Neurologic examination revealedbitemporal hemianopsia and left sixth nerve palsy. The initial radiologic diagnosis based onmagnetic resonance imaging was pituitary adenoma. A biopsy of the lesion was performed. Whileintraoperative frozen section examination could not completely exclude an “atypical” pituitaryadenoma, cytologic touch imprint findings were diagnostic of metastatic small cell carcinoma.Subsequently, additional workup revealed that the patient had a mass lesion in the right lung andright-sided mediastinal lymphadenopathy on chest computed tomography. This was a rare case ofpituitary metastasis as the first manifestation of an occult malignancy. CONCLUSION: Forintraoperative diagnosis at the time ofpituitary surgery, cytologic imprints can be used reliably tomake a diagnosis not only of pituitary adenoma but also of metastatic lesions. It is appropriate incurrent neuropathology practice that the imprint method be used as the sole modality forintraoperative consultation for pituitary lesions.
Takei,H Buckleair,L Goodman,JC Powell,SZ
Department of Pathology and Laboratory Medicine, Baylor College of Medicine,Houston, Texas 77030-3498, USA. htakei@bcm.tmc.edu
Carcinoma Diagnostic Metastatic to Lesion, NOS Adenoma
