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Images in Neurology |

Prostate Adenocarcinoma Metastasis in the Pituitary Gland

Markus J. Riemenschneider, MD; Kerim Beseoglu, MD; Daniel Hänggi, MD; Guido Reifenberger, MD, PhD
Arch Neurol. 2009;66(8):1036. doi:10.1001/archneurol.2009.146.
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A 64-year-old man with a 4-year history of disseminated adenocarcinoma of the prostate was admitted to the Department of Neurosurgery with an acute onset of diplopia and severe headaches. Neurological examination revealed an isolated right-sided palsy of the abducens nerve. Magnetic resonance imaging showed an intracranial contrast-enhancing mass located in the right-sided cavernous sinus extending into the sellar region without involvement of neighboring osseous structures (Figure 1). Radiologically, the lesion was regarded as either adenoma or meningioma and the patient underwent tumor resection via a minimally invasive binasal endoscopic transsphenoidal approach, which led to a rapid postoperative improvement of diplopia.

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Figure 1.

Radiological features. A, Axial T1-weighted magnetic resonance image with gadolinium reveals a contrast-enhancing tumor (16 mm in diameter) (arrow) in the right cavernous sinus with extension into the sellar region. B, Coronal T1-weighted magnetic resonance image. The isointense tumor (arrow) dislocates the pituitary stalk to the left. R indicates right; L, left.

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Figure 2.

Histological and immunohistochemical features. A, Small nests of epithelial tumor cells (arrow) infiltrate the anterior pituitary gland tissue (hematoxylin-eosin, original magnification ×400). B, Epithelial tumor cells immunohistochemically express prostate-specific antigen (original magnification ×400).

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