2025 Poster Presentations
P240: FROM PRIMARY TO PITUITARY: SKULL BASE TUMOR-TO-TUMOR METASTASIS INSIGHTS AND SYSTEMATIC REVIEW
Guilherme Mansur, MD; Mohammad B Alsavaf, MD; Ludovica Pasquini, MD; Moataz D Abouammo, MD, MSc; Chandrima Biswas, MD; Pavnesh Kumar, MD; Raju R Raval, MD; Peter Kobalka, MD; Ricardo L Carrau, MD; Daniel M Prevedello, MD; The Ohio State University
Background: Tumor-to-tumor metastasis within Pituitary Neuroendocrine Tumors (PitNETs) is an exceptionally rare occurrence, posing significant diagnostic and therapeutic challenges. This study aims to enhance the understanding of this phenomenon through a systematic literature review and the presentation of two illustrative case reports.
Methods: A comprehensive literature review was conducted using PubMed and Google Scholar databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review included case reports and case series involving tumor-to-tumor metastasis to PitNETs, focusing on patient demographics, primary tumor origins, clinical presentations, and treatment outcomes. Additionally, we present two cases from our institution: one involving metastasis from renal cell carcinoma and another from prostate adenocarcinoma. Data analysis included descriptive statistics and Kaplan-Meier survival analysis to evaluate the impact of different surgical approaches on patient outcomes.
Results: The literature review identified 38 documented cases of tumor-to-tumor metastasis to PitNETs. The primary tumors most commonly metastasizing to PitNETs were lung (21.1%), breast (18.4%), and renal carcinomas (10.5%). The most frequent clinical presentation was visual deficits, observed in 74% of cases, followed by headaches (21%) and diplopia (21%). Surgical resection was the primary treatment modality, with endoscopic endonasal approaches (EEA) utilized in 37% of cases, transsphenoidal surgeries (TSS) in 34%, and transcranial surgeries (TC) in 16%. Subtotal resection was achieved in 39% of cases, while gross total resection (GTR) was documented in 8%. Kaplan-Meier survival analysis indicated that patients undergoing EEA had a significantly longer median survival (12 months) compared to those undergoing TSS (6 months) and TC (0.7 months). In the first case reported, a 56-year-old male with a history of renal cell carcinoma presented with visual decline and a large sellar/suprasellar mass. Histopathological examination confirmed metastasis from renal cell carcinoma to a gonadotrophic PitNET. The second case involved a 72-year-old male with a sellar mass discovered incidentally, later confirmed to be metastatic prostate adenocarcinoma to an FSH-secreting PitNET.
Conclusion: Tumor-to-tumor metastasis to PitNETs, although rare, must be considered in the differential diagnosis of sellar masses, especially in patients with a history of malignancy. Rapid tumor growth and diverse enhancement patterns on MRI should raise suspicion of this condition. Our findings suggest that the endoscopic endonasal approach (EEA) is associated with better survival outcomes compared to other surgical methods. However, the small number of cases and specific patient subsets limit the generalizability of these results. Early and accurate diagnosis, along with a multidisciplinary treatment strategy involving oncologists, neurosurgeons, and endocrinologists, is essential for improving patient outcomes.
