Pituitary carcinoma recurrent to the lumbar intradural extramedullary space: Case report

• Published in: The Journal of Spinal Cord Medicine Vol. 35; no. 2; pp. 118 - 121
• Main Authors: Arnold, Paul M., Ratnasingam, Denesh, O'Neil, Maura F., Johnson, Philip L.
• Format: Report
• Language: English
• Published: Taylor & Francis 01.03.2012
• Subjects: ACTH-secreting; Disc; Intervertebral; Intradural-extramedullary; L2-L3; Pituitary adenoma; L3-L4; Neoplasm; Spinal cord neoplasms; Pituitary carcinoma; Metastases
• DOI: 10.1179/2045772311Y.0000000055
• ISSN: 1079-0268

Context Pituitary tumors are rare, and pituitary carcinomas are rarer still. Prognosis is poor, with less than 50% of patients surviving past 1 year after diagnosis. In this case of spinal metastasis from an adrenocorticotropic hormone-secreting pituitary carcinoma, the intradural extramedullary metastases recurred in the same lumbar area 6 years apart. Findings Fourteen years prior to presentation in our clinic, a 48-year-old woman was diagnosed with pituitary adenoma which was treated with resection followed by radiation. Eight years later, an intradural extramedullary spinal drop metastasis at L2-L3 was again treated with resection and radiation. Three years later, magnetic resonance imaging (MRI) revealed a mass encasing the right carotid artery, which was treated for 1 year with chemotherapy using temozolomide (Temodar). Three years later, MRI showed intradural extramedullary metastases at the L3-L4 intervertebral disc space and behind the L3 vertebral body; treatment was again resection followed by radiation. Back pain and weakness resolved after surgery and her neurological examination returned to baseline. There was no evidence of recurrence 1 year after surgery. Conclusion/clinical relevance In this unusual case, this pituitary carcinoma metastasized twice in 6 years to virtually the same intradural extramedullary lumbar region. Surgical resection of these masses aided in relieving neurological symptoms and prolonging life.