The early diagnosis and treatment of pituitary carcinoma is difficult. The diagnosis is often delayed, and the confirmation of a diagnosis requires the presence of distant subarachnoid,brain or systemic metastasis from the primary pituitary tumor in the sella and also needs the evidences of pathology and imaging of the primary pituitary carcinoma and metastases. Treatment of pituitary carcinoma includes surgery, radiation therapy ,hormone therapy, chemotherapy, and molecularly targeted therapy; however, these methods are mainly palliative and can not prolong the survival. The prognosis remains poor. Efforts should be made to develop more effective diagnosis and treatment options.
Diagnostic Imaging ; Humans ; Pituitary Neoplasms ; Prognosis

Pituitary metastasis,a rare kind of intracranial malignant tumor,is characterized by metastasis from all parts of the body to the pituitary.The common tumors metastatic to pituitary are abundant with blood supply,located in the posterior pituitary lobe and/or the pituitary stalk.The lesion shows infiltrative growth,and mainly demonstrates low signal on T1 weighted imaging and high signal on T2 weighted imaging.It is usually enhanced significantly after iodinated contrast administration.The metastatic tumor with poor blood supply is similar to pituitary macroadenoma on magnetic resonance image,which makes it difficult to be differentiated.We reported two cases of pathologically diagnosed pituitary metastasis with poor blood supply and reviewed related papers,aiming to provide the imaging differentiation points of hypovascular pituitary metastasis.
Contrast Media ; Humans ; Magnetic Resonance Imaging ; Pituitary Diseases ; Pituitary Gland ; Pituitary Neoplasms/diagnostic imaging*

BACKGROUNDPituitary adenomas are common intracranial tumors, with a rising incidence in China. Excision is a mainstay therapy for this disease, and is often carried out via transfrontal, transsphenoidal or transpterional approaches. However, few studies have systematically addressed the regional anatomy involved in these microsurgical procedures. The present study attempted to establish some key anatomic measurements relevant to pituitary adenoma resection based on cadaver and computer tomography (CT) image studies.

METHODSHead specimens from 30 randomly selected formalin-fixed adult cadavers were used for anatomical analysis. Measurements were made on the base of the skull following removal of brain structures above the pituitary gland, and on the mid-sagittal plane of the cranium. Parameters were designed by considering the 3 above-mentioned common microsurgical approaches, and obtained on each head using a sliding caliper. Multi-level CT images from 30 individuals were also used for distance measurements between landmark structures that are relevant to these surgeries. All data were subjected to statistical analysis using the SPSS 11.5 software.

RESULTSThere was statistically significant difference (P < 0.05) of distance measured on cadavers relative to CT images in 3 sets of measurements related to the transfrontal surgical approach, i.e., distances from the midpoint of superciliary arch superior border to the cranial entrance of internal carotid arteries (ICAs), the opposite side entrance of ICA and to the genu of ICA. While regional anatomical analyses were carried out according to the transpterional approach, statistically significant difference was also found in 3 sets of distance measurements between cadaver and CT image data, with regard to the distances between the pterion and some landmark structures around the pituitary.

CONCLUSIONSThe present study provides key anatomical and CT image measurements involving the 3 conventionally used surgical approaches for pituitary tumor resection. The data implicate that while CT scan results can provide valuable guidelines for operations, cautions and adjustments are needed during surgery for sufficient tumor excision and protection of key blood vessels and nerves in the vicinity of the pituitary gland and around the surgical pathway.

Adult ; Female ; Humans ; Male ; Pituitary Gland ; anatomy & histology ; diagnostic imaging ; Pituitary Neoplasms ; diagnostic imaging ; surgery ; Radiography

Adolescent ; Adult ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Pituitary Neoplasms ; pathology ; Thyroid Dysgenesis ; diagnostic imaging ; pathology

With improvements in diagnostic imaging techniques for the brain, pituitary tumors without neurological signs or symptoms have occasionally been found. To evaluate therapeutic strategy for incidentally found pituitary tumors ("pituitary incidentaloma"), we analyzed the result of magnetic resonance imaging findings and of ophthalmological and endocrinological studies in 3 cases with follow up. Incidentally found functioning tumors were excluded. All of 3 cases is greater than 10mm in tumor size("pituitary macroincidentaloma"). The follow-up period was 49 months, 16 months and 6 months(mean, 25.3 months) in each case. There was no evidence of tumor enlargement, endocrinological problems and visual field defect during follow-up period. Patients with pituitary incidentalomas usually follow a benign course and neurosurgical intervention is not initially required in the management even those greater than 10mm in diameter. Observation over time may be good approach to the patient with a pituitary macroincidentaloma to avoid the unnecessary risk for surgery in a patients with a stable mass.
Brain ; Diagnostic Imaging ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Pituitary Neoplasms ; Visual Fields

OBJECTIVETo evaluate the effect of 99Tcm-HYNIC-TOC imaging in localization of somatostatin receptor-positive tumors.

METHODSForty-four patients were involved in this study, including 22 neuroendocrine tumors, 10 non-neuroendrocrine tumors and 12 benign diseases. All patients were confirmed by histopathologic diagnosis, and had clinical laboratory data, or 1-2 other imaging procedures. Regional, whole body and SPECT/CT (in positive cases) imagings were acquired at 1 and 4 hours after an intravenous injection of 370 MBq 99Tcm-HYNIC-TOC. 99Tcm-HYNIC-TOC imaging was compared with 111In-petetreotide imaging in 4 cases, and with 131I-MIBG imaging in 10 cases. 99Tcm-HYNIC-TOC imaging was performed before and after treatment in 1 non-Hodgkins lymphoma (NHL) patient.

RESULTSThe positive imagings were observed in 19 of 32 cases. The sensitivity, specificity, and accuracy of 99Tcm-HYNIC-TOC imaging for somatostatin receptor-positive tumors are 82.6%, 100%, and 87.5%, respectively. The distribution in vivo of 99Tcm-HYNIC-TOC is similar to that of 111In-petetreotide, and showed high physiological uptake in liver, spleen, and kidneys. 99Tcm-HYNIC-TOC imaging demonstrated intense tumor sites uptake at 1 hour after injection, and revealed the lesions first in 6 patients among the imaging modalities, and more lesions that had not been revealed by 131I-MIBG imaging. Compared with imaging before treatment, 99Tcm-HYNIC-TOC imaging confirmed the tumor regression after treatment in 1NHL.

CONCLUSIONS99Tcm-HYNIC-TOC is promising for the diagnosis and localization of somatostatin receptor-positive tumors.

Adenoma, Chromophobe ; diagnostic imaging ; Adult ; Carcinoma, Medullary ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Neuroendocrine Tumors ; diagnostic imaging ; metabolism ; Octreotide ; analogs & derivatives ; Organotechnetium Compounds ; Pancreatic Neoplasms ; diagnostic imaging ; Pituitary Neoplasms ; diagnostic imaging ; Receptors, Somatostatin ; metabolism ; Thyroid Neoplasms ; diagnostic imaging ; Tomography, Emission-Computed, Single-Photon

Adenoma ; diagnosis ; surgery ; Aged ; Female ; Humans ; Magnetic Resonance Imaging ; Neoplasm Invasiveness ; Optic Chiasm ; pathology ; Pituitary Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Recurrence ; Treatment Outcome

Radiosurgery, or stereotactic radiosurgery, is a minimally invasive modality to treat a lesion with stereotactically focused ionizing radiation without surgical incision. Because there are no incision procedures, general anesthesia or transfusion is not required, and complications related to incisional procedures do not occur in radiosurgery. As a result, radiosurgery shows much low rates of complications than conventional open surgery with comparable cure rates. In the beginning, radiosurgery was applied only to a few intracranial diseases because a stereotactic frame was applied to the skull. Along with the development of technologies and accumulation of knowledge on radiosurgery such as medical imaging, computer, radiation physics, and radiobiology, indications of radiosurgery have been expanded in various ways. Nowadays, radiosurgery is accepted as an adjuvant treatment or a primary treatment option for many neurosurgical diseases and cancers. Cranial nerve schwannomas, brain meningiomas, pituitary adenoma, and other benign brain tumors are good indications for radiosurgery. Intracranial arteriovenous malformation, brain metastases from extracranial cancers, and trigeminal neuralgia are also well controlled by radiosurgery. Spinal metastases and various cancers are emerging indications for extracranial radiosurgery, which has been recently introduced. In this article, the authors summarized the basic concept, history, development, and future of radiosurgery as an introduction to radiosurgery.
Anesthesia, General ; Brain ; Brain Neoplasms ; Cranial Nerves ; Diagnostic Imaging ; Intracranial Arteriovenous Malformations ; Meningioma ; Neoplasm Metastasis ; Neurilemmoma ; Pituitary Neoplasms ; Radiation, Ionizing ; Radiobiology ; Radiosurgery ; Skull ; Trigeminal Neuralgia

Multiple endocrine neoplasia type 1 (MEN1) is an inherited autosomal dominant disease presenting with pancreatic neuroendocrine tumors (pNETs), parathyroid tumors, or pituitary tumors. Using the PubMed database, we reviewed the literature on information regarding the proper diagnosis and treatment of MEN1-associated pNET. Many cases of MEN1-associated pNET are functioning pNETs. Gastrinomas and insulinomas tend to occur frequently in the duodenum and pancreas, respectively. In addition to diagnostic imaging, the selective arterial secretagogue injection test (SASI test) is useful for localizing functioning pNET. The standard treatment is surgical resection. However, in the case of a functioning pNET, the tumor should first be accurately located using the SASI test before an appropriate surgical method is selected. In cases of a MEN1-associated non-functioning pNET that exceeds 2 cm in diameter, the incidence of distant metastasis is significantly increased, and surgery is recommended. In cases of unresectable pNET, a somatostatin analog has been shown to demonstrate antitumor effects and is considered to be a promising treatment. In addition, molecular-targeted drugs have recently been found to be effective in phase III clinical trials.
Diagnostic Imaging ; Duodenum ; Gastrinoma ; Incidence ; Insulinoma ; Multiple Endocrine Neoplasia ; Multiple Endocrine Neoplasia Type 1 ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive ; Neuroendocrine Tumors ; Pancreas ; Pituitary Neoplasms ; Somatostatin

BACKGROUND: Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited disorder characterized by the simultaneous occurrence of endocrine tumors in target tissues (mainly the pituitary, endocrine pancreas, and parathyroid glands). MEN1 is caused by mutations in the MEN1 gene, which functions as a tumor suppressor and consists of one untranslated exon and nine exons encoding the menin protein. This condition is usually suspected when we encounter patients diagnosed with tumors in multiple endocrine organs, as mentioned above. METHODS: A 65-year-old woman who underwent surgery for a pancreatic tumor (serous cystadenoma) 5 years previously was referred to our hospital due to neurologic symptoms of diplopia and left ptosis. Brain magnetic resonance imaging revealed a 3.4-cm lesion originating from the cavernous sinus wall and extending into the sellar region. It was thought to be a nonfunctioning tumor from the results of the combined pituitary function test. Incidentally, we found that she also had a pancreatic tumor, indicating the necessity of genetic analysis for MEN1. RESULTS: Genomic analysis using peripheral leukocytes revealed a heterozygous c.1621G>A mutation in the MEN1 gene that was previously reported to be either a pathogenic mutation or a simple polymorphism. We pursued a stereotactic approach to the pituitary lesion, and microscopic findings of the tumor revealed it to be an intrasellar cavernous hemangioma, a rare finding in the sellar region and even rarer in relation to oculomotor palsy. The patient recovered well from surgery, but refused further evaluation for the pancreatic lesion. CONCLUSION: There is great emphasis placed on genetic testing in the diagnosis of MEN1, but herein we report a case where it did not assist in diagnosis, hence, further discussion on the role of genetic testing in this disease is needed. Also, in cases of pituitary tumor with cranial nerve palsy, despite its low prevalence, intrasellar cavernous hemangioma could be suspected.
Aged ; Brain ; Cavernous Sinus ; Cranial Nerve Diseases ; Diagnosis ; Diagnostic Errors* ; Diplopia ; Exons ; Female ; Genetic Testing ; Hemangioma, Cavernous* ; Humans ; Islets of Langerhans ; Leukocytes ; Magnetic Resonance Imaging ; Multiple Endocrine Neoplasia Type 1* ; Neurologic Manifestations ; Paralysis ; Pituitary Function Tests ; Pituitary Neoplasms ; Prevalence