A Pituitary Gland Metastasis : A Case Report

患者は男で,56歳時に肺癌のため右肺上葉切除を受けた.61歳で視力・視野障害が生じ来院した.両耳側半盲と下垂体前葉機能底下があり,CT,MRIでは下垂体から鞍上部に進展する腫瘍がみられた.経蝶形骨洞的腫瘍摘出術を行い,腫瘍は肺原発巣と同じ腺癌であることが判明したが,肺癌原発巣や他臓器に再発や転移の所見はなかった.腫瘍局所と全脳へ放射線照射を行ったが,術後11ヶ月目に広範な髄膜癌腫症で死亡した.転移性下垂体腫瘍は診断時には下垂体腺腫と区別のつかない臨床症候を呈することがあるが,その予後は下垂体腺腫とは異なり,不良である.Discussed is the case of a 61-year-old male with a remote history of having undergone a pulmonary lobectomy for a lung cancer who now had developed a visual field defect with hypopituitarism. Neuro-imaging studies disclosed a pituitary mass with a suprasellar extension, and thorough preoperative examinations revealed no evidence of a recurrent disease and/or a metastasis to other organs. After a trans-sphenoidal removal of this pituitary tumor, it was found to be an adenocarcinoma. Postoperately, he then was given radiotherapy of the pitultary region and the whole brain. However, 11 months after surgery, he developed meningitis carcinomatosa and died. Although a metastatic pituitary carcinoma on presentation occasionally mimics a pituitary adenoma, unlike the prognosis of a pituitary adenoma, its prognosis is poor