PMC4720106_01
Magnetic resonance imaging of metastatic pituitary lesion. (A) At the time of diagnosis, a 35-mm strongly enhancing mass was observed in the sellar and suprasellar regions (September 2012). (B) Even after partial removal of the tumor via craniotomy and whole brain radiation therapy, viable tumor remained (27 mm, November 2012). (C) The size of the enhancing lesion had increased slightly (29 mm) 4 months after discontinuation of lapatinib and capecitabine due to gastrointestinal sepsis (June 2013). (D) After re-starting lapatinib monotherapy, the size of the enhancing mass decreased (25 mm, September 2013).
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Magnetic resonance imaging (MRI) of the patient's brain showed an enhancing mass in the sellar and suprasellar regions (Fig. 1A). Whole brain radiation therapy (30 Gy in 12 fractions) was applied (Fig. 1B), followed by weekly paclitaxel chemotherapy, but the patient was unable to finish the second cycle of paclitaxel due to toxicity (grade 3 nausea, somnolence, and loss of memory). Repeated MRIs showed a mild increase in the size of the enhancing lesion in the sella, suprasella, and the right basal ganglia (Fig. 1C). After 2 months of lapatinib monotherapy, the follow-up MRI showed a decrease in the size of the enhancing lesion (Fig. 1D).
(A) Histology of invasive ductal carcinoma showing a predominantly trabecular pattern, high nuclear atypia, and high mitotic activity (H&E staining, x100). (B) Histology of invasive ductal carcinoma metastasis to the brain, showing infiltration of malignant cells to the parenchyma (H&E staining, x100).
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Pathologic reports indicated metastatic carcinoma, which clinically originated from the breast: estrogen receptor positive (30%), progesterone receptor negative, HER2-positive (3+ by immunohistochemistry) (Fig. 2).
Due to gastrointestinal sepsis, the patient's serum sodium level changed radically (March to April, 2013), and it was stabilized after the tumor was controlled by lapatinib (November 2013).
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In addition to poor general condition, her serum sodium level changed rapidly despite treatment with desmopressin as panhypopituitarism originated from the metastatic brain lesion (Fig. 3).