Hostname: page-component-76fb5796d-22dnz Total loading time: 0 Render date: 2024-04-26T20:19:42.924Z Has data issue: false hasContentIssue false
  • English
  • Français

Sarcomatous Change After Sellar Irradiation in a Growth Hormone-Secreting Pituitary Adenoma

Published online by Cambridge University Press:  02 December 2014

Sujit S. Prabhu ,
Kenneth D. Aldape ,
Robert F. Gagel ,
Robert S. Benjamin ,
Jonathan C. Trent  and
Ian E. McCutcheon
Sujit S. Prabhu
Affiliation:
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 USA Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 USA
Kenneth D. Aldape
Affiliation:
Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 USA Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 USA
Robert F. Gagel
Affiliation:
Division of Cancer, Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 USA
Robert S. Benjamin
Affiliation:
Sarcoma Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 USA
Jonathan C. Trent
Affiliation:
Sarcoma Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 USA
Ian E. McCutcheon
Affiliation:
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 USA Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 USA
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Although the benefits of radiotherapy for pituitary adenomas are well-documented, post-irradiation sarcomas of the sella are rarely seen, with only 20 cases (mainly of fibrosarcoma) reported in the medical literature.

Method:

We describe a case of post-irradiation sarcoma five years after surgery followed by external-beam irradiation for an extensive and locally invasive growth hormone-secreting tumor. The patient was subsequently given pegvisomant, an antagonist of growth hormone receptor, to control symptoms of growth hormone excess.

Results:

The patient underwent transsphenoidal resection of the recurrent tumor, followed by adjuvant chemotherapy. This led to significant relief in the patient's symptoms including radiological evidence of tumor shrinkage, but the tumor regrew when, owing to dose-limiting toxicity, chemotherapy was stopped.

Conclusion:

Post-irradiation sarcomas of the pituitary are well-recognized but rare. They should be suspected in patients following sellar irradiation who show abrupt onset of new symptoms and appropriate radiological findings, and such tumors may respond to cytotoxic chemotherapy.

Résumé:

RÉSUMÉ:Introduction:

Bien que les bénéfices de la radiothérapie soient bien documentés dans le traitement des adénomes pituitaires, les sarcomes de la selle turcique postirradiation sont rares, seulement 20 cas ayant été rapportés dans la littérature médicale, surtout des fibrosarcomes.

Méthodes:

Nous décrivons un cas de sarcome post-irradiation cinq ans après une chirurgie suivie d’irradiation pour traiter une tumeur extensive avec envahissement local secrétant de l’hormone de croissance. Le patient a reçu par la suite du pegvisomant, un antagoniste des récepteurs de l’hormone de croissance, pour contrôler les symptômes causés par un excès d’hormone de croissance.

Résultats:

Le patient a subi une résection transsphénoïdale de la récidive tumorale suivie par une chimiothérapie adjuvante. Les symptômes du patient ont considérablement diminué et on a observé une régression de la tumeur. Cependant il y a eu récidive de la tumeur quand la chimiothérapie a dï être arrêtée à cause de sa toxicité.

Conclusions:

Les sarcomes de l’hypophyse après irradiation sont bien connus mais rares. On doit soupçonner leur présence chez les patients qui ont subi une irradiation de la selle turcique et qui présentent subitement de nouveaux symptômes et des signes radiologiques appropriés. Ces tumeurs peuvent répondre à la chimiothérapie cytotoxique.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 4 , November 2003 , pp. 378 - 383
Copyright
Copyright © The Canadian Journal of Neurological 2003

References

1. Ahmad, K, Fayos, JV. Pituitary fibrosarcoma secondary to radiation therapy. Cancer 1978; 42: 107–110.3.0.CO;2-K>CrossRefGoogle ScholarPubMed
2. Ahmed, M, Kanaan, I, Rifai, A, Tulbahq, A, Ghannam, N. An unusual treatment-related complication in a patient with growth hormone-secreting pituitary tumor. J Clin Endocrinol Metab 1997; 82: 2816–2820.Google Scholar
3. Coppeto, JR, Roberts, M. Fibrosarcoma after proton-beam pituitary ablation. Arch Neurol 1979; 36: 380–381.Google Scholar
4. Gnanalingham, KK, Chakraborty, A, Galloway, M, Revesz, T, Powell, M. Osteosarcoma and fibrosarcoma caused by postoperative radiotherapy for a pituitary adenoma. Case report. J Neurosurg 2002; 96: 960–963.Google Scholar
5. Goldberg, MB, Sheline, GE, Malamud, N. Malignant intracranial neoplasms following radiation therapy for acromegaly. Radiology 1962; 80: 465–470.CrossRefGoogle Scholar
6. Greenhouse, AH. Pituitary sarcoma. A possible consequence of radiation. J Am Med Assoc 1960; 190: 269–273.Google Scholar
7. Martin, WH, Cail, WS, Morris, JL, Constable, WC. Fibrosarcoma after high-energy radiation therapy for pituitary adenoma. AJR Am J Roentgenol 1980; 135: 1087–1090.Google Scholar
8. Nagatani, M, Ikeda, T, Otsuki, H, et al. [Sellar fibrosarcoma following radiotherapy for prolactinoma]. No Shinkei Geka 1984; 12: 339–346.Google ScholarPubMed
9. Pieterse, S, Dinning, TA, Blumbergs, PC. Postirradiation sarcomatous transformation of a pituitary adenoma: a combined pituitary tumor. Case report. J Neurosurg 1982; 56: 283–286.Google Scholar
10. Powell, HC, Marshall, LF, Ignelzi, RJ. Postirradiation pituitary sarcoma. Acta Neuropathol (Berl) 1977; 39: 165–167.CrossRefGoogle ScholarPubMed
11. Shi, T, Farrell, MA, Kaufmann, JC. Fibrosarcoma complicating irradiated pituitary adenoma. Surg Neurol 1984; 22: 277–284.CrossRefGoogle ScholarPubMed
12. Shin, H, Namba, H, Ishige, N, et al. [Pituitary fibrosarcoma secondary to radiation therapy for the treatment of chromophobe adenoma]. No Shinkei Geka 1980; 8: 605–614.Google Scholar
13. Terry, RD, Hyams, VJ, Davidoff, LM. Combined nonmetastasizing fibrosarcoma and chromophobe tumor of the pituitary. Cancer 1959; 12: 791–798.Google Scholar
14. Waltz, TA, Brownell, B. Sarcoma: a possible late result of effective radiation therapy for pituitary adenoma. Report of two cases. J Neurosurg 1966; 24: 901–907.Google Scholar
15. Wheelock, MC. Eosinophilic adenoma of the pituitary with sarcomatous changes. Cancer Sem 1963; 3: 77–80.Google Scholar
16. Drake, WM, Parkinson, C, Besser, GM, Trainer, PJ. Clinical use of a growth hormone receptor antagonist in the treatment of acromegaly. Trends Endocrinol Metab 2001; 12: 408–413.CrossRefGoogle ScholarPubMed
17. Trainer, PJ, Drake, WM, Katznelson, L, et al. Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N Engl J Med 2000; 342: 1171–1177.CrossRefGoogle ScholarPubMed
18. Utiger, RD. Treatment of acromegaly. N Engl J Med 2000; 342: 1210–1211.CrossRefGoogle ScholarPubMed
19. Reichenthal, E, Cohen, ML, Manor, CR, et al. Primary osteogenic sarcoma of the sellar region. Case report. J Neurosurg 1981; 55: 299–302.Google Scholar
20. Bots, GT, Tijssen, CC, Wijnalda, D, Teepen, JL. Alveolar soft part sarcoma of the pituitary gland with secondary involvement of the right cerebral ventricle. Br J Neurosurg 1988;2: 101–107.CrossRefGoogle ScholarPubMed
21. Jalalah, S, Kovacs, K, Horvath, E, et al. Rhabdomyosarcoma in the region of the sella turcica. Acta Neurochir (Wien) 1987; 88: 142–146.Google Scholar
22. Allan, CA, Kaltsas, G, Evanson, J, et al. Pituitary chondrosarcoma: an unusual cause of a sellar mass presenting as a pituitary adenoma. J Clin Endocrinol Metab 2001; 86: 386–391.Google Scholar
23. Lopes, MB, Lanzino, G, Cloft, HJ, et al. Primary fibrosarcoma of the sella unrelated to previous radiation therapy. Mod Pathol 1998; 11: 579–584.Google ScholarPubMed
24. Tachibana, E, Saito, K, Wakabayashi, T, et al. Sarcomatous transformation of a prolactinoma associated with development of a fatal internal carotid artery pseudoaneurysm--case report. Neurol Med Chir (Tokyo) 2000; 40: 427–431.CrossRefGoogle ScholarPubMed
25. Nagasaka, T, Nakashima, N, Furui, A, Wakayabashi, T, Yoshida, J. Sarcomatous transformation of pituitary adenoma after bromocriptine therapy. Hum Pathol 1998; 29: 190–193.Google Scholar
26. Patel, SR. Radiation-induced sarcoma. Curr Treat Options Oncol 2000; 1: 258–261.Google Scholar
27. Thoren, M, Hoybye, C, Grenback, E, et al. The role of gamma knife radiosurgery in the management of pituitary adenomas. J Neuro-Oncol 2001; 54: 197–203.Google Scholar
28. Thomsen, J, Mirz, F, Wetke, R, et al. Intracranial sarcoma in a patient with neurofibromatosis type 2 treated with gamma knife radiosurgery for vestibular schwannoma. Am J Otol 2000; 21: 364–370.Google Scholar
29. Amine, ARC, Sugar, O. Suprasellar osteogenic sarcoma following radiation for pituitary adenoma. J Neurosurg 1976; 44: 88–90.CrossRefGoogle ScholarPubMed
30. Lach, M, Wallace, CJ, Krcek, J, Curry, B. Radiation-associated gliosarcoma. Can Assoc Radiol J 1996; 47: 209–212.Google Scholar
31. Wright, AD, Hill, DM, Lowy, C, Fraser, TR. Mortality in acromegaly. Q J Med 1970; 39: 1–16.Google ScholarPubMed
32. Nabarro, JD. Acromegaly. Clin Endocrinol 1987; 26: 481–512.Google Scholar
33. Barzilay, J, Heatley, GJ, Cushing, GW. Benign and malignant tumors in patients with acromegaly. Arch Int Med 1991; 151: 1629–1632.Google Scholar
34. Remmelink, M, Decaestecker, C, Darro, F, et al. The in vitro influence of eight hormones and growth factors on the proliferation of eight sarcoma cell lines. J Cancer Res Clin Oncol 1998; 124: 155–164.CrossRefGoogle ScholarPubMed
35. Schlessinger, J. Cell signaling by receptor tyrosine kinases. Cell 2000; 103: 211–225.Google Scholar
36. Heron-Milhavet, L, LeRoith, D. Insulin-like growth factor I induces MDM2-dependent degradation of p53 via the p38 MAPK pathway in response to DNA damage. J Biol Chem 2002; 277: 15600–15606.Google Scholar