Prolactin-Secreting Lung Adenocarcinoma Metastatic to the Pituitary Mimicking a Prolactinoma: A Case Report
Prolactin-Secreting Lung Adenocarcinoma Metastatic to the Pituitary Mimicking a Prolactinoma: A Case Report
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分泌催乳素的肺腺癌转移至垂体，类似催乳素瘤：一例报告
DOI：
10.1093/neuros/nyy386
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发表时间：
2019-10-01
期刊：
影响因子：
4.8
通讯作者：
Wu, Zhebao
中科院分区：
文献类型：
--
作者：
Yao, Hong;Rui, Weiwei;Wu, Zhebao
背景和重要性：在系统性播散性肿瘤患者中，脑垂体转移并不常见。个别文章已经报道了类似催乳素瘤的垂体转移病例，但到目前为止还没有催乳素分泌肿瘤转移到类似催乳素瘤的垂体的病例报道。临床表现：本文报告了一位67岁男性患者，近期出现头痛、眼麻痹、垂体功能低下和高泌乳素血症，最初诊断为泌乳素瘤，并在当地医院给予溴隐亭治疗。因服药后出现呕吐，转至我院进一步诊治。血清泌乳素升高至1022 ng/mL，垂体磁共振成像显示2.9 x 2.8 x 2.3 cm鞍区肿块伴垂体卒中，行经蝶窦内镜手术。术后病理及免疫印迹显示为催乳素阳性转移性肺腺癌。全外显子组测序显示了KRAS、PIK3CA、ALK和CTNNB1等基因突变。患者在初步诊断后3个月死于肺部疾病恶化。结论：据我们所知，这是第一个通过免疫组织化学和免疫印迹证实的泌乳素分泌肿瘤转移到垂体模拟泌乳素瘤的报道。催乳素的分泌是罕见和难以捉摸的，可能与特定的基因突变有关。
BACKGROUND AND IMPORTANCE: Metastasis to the pituitary gland is uncommon in patients with systemic disseminated cancer. Individual articles have reported cases of pituitary metastasis mimicking a prolactinoma, but no case of a prolactin-secreting tumor metastasizing to the pituitary mimicking a prolactinoma has been reported so far.CLINICAL PRESENTATION: This article reports a 67-yr-old man with a recent onset of headaches, ophthalmoplegia, hypopituitarism, and hyperprolactinemia who was initially diagnosed with prolactinoma and given bromocriptine in the local hospital. Because of vomiting after taking drugs, he was transferred to our hospital for further diagnosis and treatment. Serum prolactin was elevated up to 1022 ng/mL, and pituitary magnetic resonance imaging revealed a 2.9 x 2.8 x 2.3 cm sellar mass with pituitary apoplexy, for which endoscopic transsphenoidal surgery was performed. Postoperative pathology and western blotting disclosed a prolactin-positive metastatic lung adenocarcinoma. Whole exome sequencing revealed a number of gene mutations including KRAS, PIK3CA, ALK, and CTNNB1. The patient died of deterioration of the lung disease 3 mo after the initial diagnosis.CONCLUSION: To the best of our knowledge, this is the first report of a prolactin-secreting tumor metastasizing to the pituitary mimicking a prolactinoma as confirmed by both immunohistochemistry and western blot. Prolactin secretion is rare and elusive, and may associate with specified gene mutations.