Abstract: SAT 525

A Rare Case of Bronchial Carcinoid Metastatic to Sella Turcica

Presenter:


Abstract


Introduction:
Neuroendocrine tumors are a group of malignancies arising from specialized cells releasing hormones or amines or may sometimes be non-functioning, and can arise from any part of the body. They can be sporadic or be a part of genetic syndromes like  Multiple Endocrine neoplasia. Metastasis to sella is an uncommon finding but a serious complication carrying a poor prognosis. We present a rare case of metastasis to sella from a bronchial carcinoid. 
Case Description: view more

Introduction:
Neuroendocrine tumors are a group of malignancies arising from specialized cells releasing hormones or amines or may sometimes be non-functioning, and can arise from any part of the body. They can be sporadic or be a part of genetic syndromes like  Multiple Endocrine neoplasia. Metastasis to sella is an uncommon finding but a serious complication carrying a poor prognosis. We present a rare case of metastasis to sella from a bronchial carcinoid. 
Case Description:
76 year old female presented to the emergency room with a 4 to 6 week history of falls due to problems with maintaining her balance and impaired vision. She previously had left lung lobectomy for known bronchial carcinoid which was metastatic to her liver, kidneys and spine. She was maintained on monthly denosumab and octreotide injections. She did not report any headache, nausea or vomiting. Physical examination revealed decreased visual acuity and bi-temporal hemianopsia with no evidence of optic atrophy. Magnetic resonance imaging of  brain revealed a 2.4 x 2.3 x 2.0 cm sellar mass impinging on the optic chiasm. Pituitary work-up revealed no abnormality of the thyroid, adrenal or gonadal axis, and serum prolactin was normal. Chromogrannin A was found to be mildly elevated compared to her baseline. The patient then underwent a pterional craniotomy for excision of  sellar mass and did fairly well post operatively except for hyponatremia which resolved with modest fluid restriction.Post operatively she did not need any hormone replacements.The pathology from surgical specimen of pituitary tumor and the lung tumor were compared and evaluated by histology and immunohistochemistry.Sellar mass showed positivity for thyroid transcription factor -1 supporting a diagnosis of metastatic lung carcinoid.
 Discussion:
Sellar metastasis of carcinoid is uncommon. Therapy depends on the type of primary tumor with transphenoidal surgery or craniotomy being the best approach for relief of acute sellar syndrome with visual deficits. Since our patient presented with no headaches and intact pituitary function panel our initial working diagnosis was a non-functioning pituitary adenoma. Upon further literature review of a few published cases of carcinoid metastatic to sella we found that visual deficits and gait problems with weakness may be a common finding at presentation when compared to other malignancies that metastasize to pituitary usually present with diabetes insipidus.
Conclusion:
There are a few published reports of sellar metastasis of a carcinoid. Clinical history and presentation with imaging will help differentiate metastasis from an atypical adenoma which was a differential in this case. As in the patient presented here none of the published case reports with well differentiated carcinoid had diabetes insipidus at presentation.

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