Symptomatic pituitary metastasis from hepatocellular carcinoma: a case report and literature review

Figures & data

Figure 1. Preoperative MRI T1 with contrast, CTA, and ophthalmic examination. Enhanced Axial (A, B), sagittal (C), and coronal (D) MRI showed a sellar pituitary mass with sphenoidal extension and invasion. The right ICA was compressed and shifted posteriorly. The optic chiasm was not affected. 3D reconstruction (E), coronal (F), coronal with and without (G) contrast showed that the main portion of the tumor (*) was located in the sphenoidal sinus. The right ICA and the optic canal were involved (H). (I, J) The test revealed a severe visual field defect on the right side and a slight defect on the left side. (K) The patient presented a symptom with CN III palsy.

Figure 2. Intraoperative snapshot and histological tumor specimens. (A, B) exhibited the tumor (*) was soft and with abundant blood supply. (C, D) Post-operative MRI indicated the mass effect of the tumor was resolved and the right ICA was returned to normal locality. (E) Hematoxylin and eosin staining of the pituitary tumor demonstrating a tumor without pituitary tissues. Immunohistochemical expression of (F) hepatocytes, (G) ki67, and (H) CK18. Bar: 60 μm.

Figure 3. Post-operative PET-CT scan. PET-CT showed high radioactive uptake in the right and anterior abdominal wall (A), liver lobe (B, C), colonic wall (D), and active lesions in the sphenoid sinus (E).

Table 1. Pooled analysis of HCC-derived PM.

Author	Year	Age	Gender	CA History	Met.	Symptom	Cav sinus invasion	Endocrinological assessment	DI	Visual defect	Extensive of invasion	Tumor size (cm)	Surgical option	Tumor texture	Additional radiotherapy or chemotherapy	Tumor hemorrage	Recurrence	Survival (months)	Outcome
Morita et al.	1998	N/R	N/R	N/R	N/R	N/R	N/R	N/R	N/R	N/R	N/R	N/R	N/R	N/R	N/R	No	N/R	N/R	N/R
Aung et al.	2002	40	M	Y	Y	Diplopia, HA, right 6th nerve palsy	Y	Endocrinological dysfunction	N	Bilateral	Pituitary fossa, clivus, sphenoid sinus, petrous apex	2.38 × 2.5 × 3.0	Partial excision	N/R	No	No	No	3	Died
Aung et al.	2002	71	M	N	Bone	Diplopia, ptosis, HA, 3rd and 6th CN palsies	Y	Increasing PRL	N	Bilateral	Pituitary fossa, cavernous sinus	1.67 × 3.66 × 1.7	Total removal	N/R	Radiotherapy	No	No	12	Died
Karamouzis et al.	2003	59	M	Y	Bone	HA, vision disturbance	N/R	Normal	N	Bilateral	Sellar region	N/R	Partial excision	Hard and highly vascularized	No	No	No	24	Alive
Komninos et al.	2004	68	M	N	None	Ptosis, diplopia, vision loss	Y	Endocrinological dysfunction	Y	Bilateral	clivusm sella turica, sphenoid sinus	2.9 × 1.8	Decompressive surgery	Hard and highly vascularized	Radiotherapy	No	No	3	Died
Hirsch et al.	2005	46	M	N	Adrenal	Sudden HA, blurred vision, cav sinus syndrome including 3–6 CNs palsies	Y	Normal	N	N/R	Cavernous sinus, sphenoidal sinus	2.2 × 2.4 × 2.7	Total removal	N/R	Radiotherapy	No	Yes	12	Died
Moreno-Perez et al.	2007	65	M	N	None	Ptosis, visual loss, diaplopia, 3rd CN palsy, HA	Y	Gonadotroph cell insufficiency	N	Bilateral	Sella, cavernous sinus	3.0 × 3.0	Partial excision	N/R	No	No	Yes	5	Died
Takigawa et al.	2011	58	M	Y	Bone	Diplopia, 3rd nerve palsy, vision loss	Y	Normal	N	Bilateral	Clivus, sella turcia, bilaterial sphenoid sinuses	N/R	Partial excision	Hard and highly vascularized	No	Nasal hemorrhage	Yes	12	Died
Wilson et al.	2013	50	M	N	Lung and spin	HA, diplopia, 3rd and 6th nerves palsies	Y	Normal	N	N/R	Clivusm, cavernous sinus, sella turcica	3.0 × 2.9 × 1.5	Total removal	N/R	N/R	No	No	N/R	N/R
Tamura et al.	2013	67	M	Y	None	Diplopia, HA	Y	Normal	Y	Bilateral	Clivus	2.0 × 3.0	Partial excision	Hard and highly vascularized	Radiotherapy	No	No	15	Died
Tamura et al.	2013	58	M	N	None	HA, visual disturbance, 3rd nerve palsy	Y	Normal	Y	Bilateral	Cavernous sinus	N/R	N/R	N/R	Radiotherapy	Nasal hemorrhage	Yes	4.5	Died
Tanaka et al.	2015	80	F	Y	Bone	Anorexia, hypotension, bradycardia	Y	Panhypopituitarism	Y	N/R	Sella turcica	1.3 × 1.3	N/R	N/R	No	No	No	3	Died
He et al.	2015	49	M	N	None	Vision loss; diplopia; HA; right 3rd, 4th, 6th nerve palsies	Y	Normal	N	N/R	Clivusm, cavernous sinus, sella turcica	1.5 × 3.0 × 2.9	Total removal	N/R	Both	No	No	3	Died
Rocca et al.	2017	56	M	Y	None	Ptosis, 3rd, 4th, and 6th nerves palsies, HA	Y	Increasing PRL	N	N/R	Clivus, dura mater, sphenoidal sinus mucosa	1.8 × 2.0 × 2.1	Total removal	Soft and highly vascularized	No	Intraoperative bleeding	No	2	Died
Mishima et al.	2019	76	F	N	None	6th nerve palsy	Y	Normal	N	N/R	Clivus, cavernous sinus	N/R	Subtotal removal	Soft and highly vascularized	No	No	No	6	Died
Current	2020	50	M	Y	Lung and vertebral column	HA, visual loss	Y	Normal	N	Only right side	Clivus, cavernous sinus	2.9 × 2.8 × 2.3	Total removal	Soft and highly vascularized	No	No	No	3	Died

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Data availability statement

The data and materials supporting this study are available, without breaching participant confidentiality, in the Harvard Dataverse Repository [https://dataverse.harvard.edu/] at https://doi.org/10.7910/DVN/PWXGFD.