Pituitary carcinoma.: Anatomic and clinical features of cases reported in literature

Background and purpose. - Pituitary gland tumors that became aggressive, implying adjacent bone structure and the brain as metastases outside of the cranial box, are referred to as pituitary carcinomas. Methods. - We reviewed 67 cases reported in the literature [44 corticotropic pituitary tumors, 11 PRE tumors, 3 GH tumors, 1 TSH tumor, 3 gonadotropic cell tumors and 5 non-functioning tumors]. Results. - The corticotropic tumors occurred in 23 female and 15 males. Signs of hypercorticism were characteristic: generalized melanosis before adrenalectomy (N = 1); headache (N = 1); altered visual (N = 1); diabetes insipidus (N = 1); amenorrhea (N = 1); Cushing syndrome (N = 2); weight loss (N = 1); refractory hypokaliemic alkalosis (N = 1); diabetes mellitus (N = 1); hypertension (N = 1). ACTH, betalipotrophin, betaendorpbin, alphamelano-stimulating hormone, CRH, and beta-gamma MSH were contributive while ultrastructural microscopy provided little information, as did an equimolar Lph/ACTH ratio. The possible association of prolactin tumors with corticotrophin forms has been underlined. The characteristic feature is a time interval from the initial diagnosis of adenoma to that of cancer, which has ranged from 0.3 to 18 years (mean: 6.6 years; median: 5.0 years). Conclusion. - Corticotropic tumors resistance to high-dose medical treatment are usually aggressive tumors with a risk of recurrence after surgical treatment or even radiotherapy with the risk of metastases. GH tumors appear to predominate although it is known that these cancers can develop in association with corticotrophin cancers or with prolactin cell tumors. (C) 2007 Elsevier Masson SAS.