Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the Literature

Table 2

Prior reported cases of ectopic pituitary adenomas located in the clivus.

(a)

Authors	Patient age and gender	Immunostaining	Initial presentation
Ortiz-Suarez and Erickson, 1975 [11]	15 F	ACTH	Obesity, irregular menstrual cycles, increased facial hair, episodic headaches, and facial numbness
Shenker et al., 1986 [21]	49 M	Prolactin	Worsening renal failure, hypercalcemia, duodenal ulcer, parathyroid hyperplasia, fatigue, muscle pains, vomiting, and impotence
Anand et al., 1993 [18]	58 F	ACTH	Nasal obstruction, blurred vision, anosmia, and headache
Mount et al., 1993 [20]	71 M	Prolactin	Aphasia and R hemiplegia
Arnesen and Scheithauer, 1994 [7]	40 M	Prolactin	Bloody, mucoid nasal discharge, and nasal obstruction
Kikuchi et al., 1994 [12]	49 F	Null cell	Headaches, nausea, and vomiting after neck injury; incidentally discovered
Wong et al., 1995 [4]	67 M	Null cell	Unknown
De Witte et al., 1998 [19]	47 F	Prolactin	Headache
Hori et al., 1999 [17]	63 M	Null cell	Visual disturbances
Ballaux et al., 1999 [14]	80 F	Prolactin	Minor headache and transient amnesia
Sakakibara et al., 2002 [6]	70 F	Prolactin	Progressive L sided exophthalmos
Bhatoe et al., 2007 [5]	35 F	GH	Dull generalized headache, acral enlargement, weight gain, and coarsening facial features
Rocque et al., 2009 [9]	20 M	Prolactin	Bilateral gynecomastia and galactorrhea
Appel et al., 2012 [8]	50 F	GH/prolactin	Daily headaches, impaired concentration, fatigue, generalized muscle/joint pain, and acromegalic facial features
Mudd et al., 2012 [14]	78 M	Null cell	Acute onset blurred vision, apoplexy
Narese et al., 2015 [4]	65 M	Prolactin	Right ptosis, eyelid edema, and headache
This paper	41 M	Prolactin	Incidental imaging due to chronic neck and lower back pain

(b)

Focal neurological findings	Imaging	Abnormal preoperative labs (ng/mL)	Treatment	Follow-up; outcomes
Oculomotor and trigeminal nerve palsies	Skull XR: mottling, sclerosis of sella turcica, and lesser wing of sphenoid. CT: normal.; Carotid angiogram: medial displacement of ICA	None	Right transfrontal craniotomy + 5000 Rads	1 year; returned to baseline
None	Skull XR: enlarged sella, CT: partially empty sella, destroyed sella floor, and mass at base of sella with invasion into sphenoid sinus	PRL = 1900	Endonasal transsphenoidal resection + cabergoline	1 year; no recurrence, impotence resolved
L eye inferior medial quadrant visual field defect	MRI: 3 × 3 cm, midline homogenous mass filling posterior nasopharynx and clivus	None	Total resection via open-door maxillotomy approach + 4550 Rads over 25	1 year; complete resolution of symptoms
Unknown	CT/MRI: L frontotemporal hematoma, meningioma, expansile density with invasion into sphenoid bone and clivus, and encasing ICAs	None	Endonasal transsphenoidal biopsy only + radiation	No improvement, transferred to receive supportive care
Unknown	MRI: tumor eroding through skull base into the clivus extending into sphenoid sinus, cavernous sinus, and surrounding ICA	Unknown	Partial endonasal transsphenoidal resection	Unknown
None	Skull XR: normal size sella, slight erosion of floor CT/MRI: large enhancing mass in sphenoid sinus invading sphenoid wing and clivus	None	Partial resection via sublabial transnasal approach + 50 Gy radiation/6 wks	Unclear; “under careful observation”
Unknown	MRI: clival destruction	PRL = 7	Unknown	Unknown
None	CT/MRI: clival lesion, destruction of bone	None (Post-op PRL = 34,000)	Endonasal transsphenoidal partial resection + bromocriptine	4 months; normalization of lab values
Bitemporal hemianopsia	CT: lesion in extradural sella-clivus region	Unknown	Transfacial surgery	Unknown
None	CT: tumor at clivus with surrounding bony destruction. MRI: enhancing mass with cystic component, invading sphenoid sinus	PRL = 2519.8	Cabergoline only	6 months; resolution of lab values and symptoms
Exophthalmos with external ocular movement disorders and decreased visual acuity on L	CT: bony destruction of clivus, sphenoid sinus, and medial aspect of middle cranial fossa, MRI: abnormal enhancement in sphenoid sinus	PRL = 645.7	Endonasal transsphenoidal resection + Bromocriptine therapy	1 year f/u; resolution of visual symptoms
Unknown	Skull radiograph: normal, MRI: clival mass connected to intrasellar lesion	GH = 30.6	Endonasal transsphenoidal resection	1 year; normalization of lab values
None	MRI: 13 mm erosive mass in clivus with focal area of bony erosion	PRL = 178	Endonasal transsphenoidal total resection	6 months; complete resolution of symptoms
None	MRI: 2 mm hypointense lesion on pituitary gland. Clival lesion discovered incidentally during surgery	IGF-1 = 937, PRL = 26	Endoscopic transsphenoidal; clival mass encountered and resected, pituitary unremarkable	3 months; normalization of lab values, no report on clinical status
L CN 6 palsy	MRI: lytic lesion of left clivus, compression of cavernous sinuses, clival mass, and normal sella	None	Endoscopic transsphenoidal resection	2.5 years; resolution of CN6 palsy and no recurrence
None	MRI: large tumor at height of clivus, partial destruction of surrounding bone structure	Unknown	Endoscopic transsphenoidal resection	Unknown
None	MRI: enhancing lesion in clivus with extension into cavernous sinuses and encasement of the ICAs	PRL = 881.3	Endoscopic transsphenoidal; subtotal resection and dopamine antagonist	1 year; no symptoms

F = female.
M = male.
GH = growth hormone.
PRL = prolactin.
ACTH = adrenocorticotropic hormone.
IGF-1 = insulin-like growth factor-1.
MRI = magnetic resonance imaging.
CT = computed tomography.
XR = X-ray.
ICAs = internal carotid arteries.
L = left.
CN = cranial nerve.