Table of Contents Author Guidelines Submit a Manuscript
Case Reports in Oncological Medicine
Volume 2015 (2015), Article ID 810367, 4 pages
http://dx.doi.org/10.1155/2015/810367
Case Report

Progression of an Invasive ACTH Pituitary Macroadenoma with Cushing’s Disease to Pituitary Carcinoma

1Neuroendocrinology Unit, Functional Neurosurgery Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, Brazil
2Pituitary Neurosurgery Unit, Functional Neurosurgery Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, Brazil

Received 27 March 2015; Revised 21 July 2015; Accepted 22 July 2015

Academic Editor: Cesar V. Reyes

Copyright © 2015 Clarissa Groberio Borba et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pituitary carcinomas are very rare tumors that in most cases produce prolactin and adrenocorticotropic hormone (ACTH). It is a challenge to diagnosis of a pituitary carcinoma before disclosed symptomatic metastasis. We report the case of a female patient with Cushing’s disease who underwent three transsphenoidal surgeries, with pathological findings of common ACTH pituitary adenoma including Ki-67 expression <3%. She achieved hypocortisolism after the 3rd surgery although ACTH levels remained slightly elevated. The patient returned some time later with fast worsening of hypercortisolism. Magnetic resonance imaging showed clivus invasion, which led to a fourth surgery and radiation. This time, immunohistochemistry revealed strong Ki-67 (10% to 15%) and p53 expression. Liver and lumbar spine metastases were found on workup. The patient died after few months due to lung infection. Pituitary carcinomas are rare, and the transformation of an ACTH-secreting pituitary adenoma into a carcinoma is exceptional. The difficulty of defining markers for the diagnosis of carcinoma, before metastasis diagnosis, in order to change the management of the disease, is a challenge.