Prolactin-secreting pituitary carcinomas with intra- and extracranial metastasis: case report and review

Astafieva LI, Chernov IV, Kobyakov GL, et al. . Prolactin-secreting pituitary carcinomas with intra- and extracranial metastasis: case report and review. Burdenko's Journal of Neurosurgery. 2025;89(1):83‑93. (In Russ., In Engl.)
https://doi.org/10.17116/neiro20258901183

Подписка 2025 Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко (Burdenko's Journal of Neurosurgery)

Использование инфографики авторами научных работ

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Abstract:

According to the modern WHO classification, pituitary carcinomas (or metastatic neuroendocrine pituitary tumors) are pituitary tumors with confirmed craniospinal and/or distant metastases. The main goal of histological analysis of pituitary carcinomas is to confirm pituitary origin of metastases. Treatment usually includes surgery and radiotherapy, dopamine agonists in maximum possible doses in case of prolactin-secreting pituitary carcinomas and chemotherapy with preferable temozolomide.

OBJECTIVE

To present the results of diagnosis and treatment of two patients with prolactin-secreting pituitary carcinomas.

MATERIAL AND METHODS

The authors describe 2 patients with prolactin-secreting pituitary carcinomas arising from drug-resistant aggressive prolactinomas with histologically confirmed metastases. In both cases, combined treatment included surgery, radio- and chemotherapy (cabergoline and temozolomide).

RESULTS

A 47-year-old patient underwent surgery, radio- and dopamine agonist therapy with subsequent regression of tumor growth in the follow-up period. However, progressive increase in prolactin concentration necessitated PET/CT with detection of multiple metastases in bones and lymph nodes. Temozolomide therapy led to temporary shrinkage of metastatic foci with subsequent progression. The second case was characterized by multiple brain and spinal cord metastases in a 47-year-old woman. Resection of intracranial metastasis and temozolomide therapy stabilized the disease and normalized serum prolactin throughout 2-year follow-up with subsequent progression.

CONCLUSION

Pituitary carcinoma is a rare tumor with unfavorable prognosis. Treatment is currently not standardized and determined by available world experience regarding various chemotherapeutic drugs. Temozolomide is the most effective drug. However, short-term remission is usually followed by subsequent disease progression in most cases.

Keywords:

aggressive pituitary tumor

prolactinoma

pituitary carcinoma

pituitary neuroendocrine tumor

temozolomide

Authors:

Astafieva L.I.

Burdenko Neurosurgical Center

ORCID: 0000-0003-4480-1902

Chernov I.V.

Burdenko Neurosurgical Center

ORCID: 0000-0002-9789-3452

Kobyakov G.L.

Botkin Moscow Multidisciplinary Scientific Clinical Center

SPIN RSCI: 6138-9206
Scopus AuthorID: 56013296300
ORCID: 0000-0002-7651-4214

Trunin Yu.Yu.

Burdenko Neurosurgical Center

ORCID: 0000-0002-4240-5036

Shishkina L.V.

Burdenko Neurosurgical Center

ORCID: 0000-0001-7045-7223

Shkarubo A.N.

Russian Medical Academy of Continuous Professional Education

ORCID: 0000-0003-3445-3115

Fomichev D.V.

Burdenko Neurosurgical Center

ORCID: 0000-0002-5323-1000

Sidneva Yu.G.

Research Institute of Emergency Pediatric Surgery and Traumatology

ORCID: 0000-0003-2733-5874

Vagapova G.R.

Kazan State Medical Academy

ORCID: 0000-0001-8493-7893

Kalinin P.L.

Burdenko Neurosurgical Center

ORCID: 0000-0001-9333-9473

Received:

01.08.2024

Accepted:

21.11.2024

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