Pituitary Metastasis Clinical Presentation of Diabetes Insipidus Six Years after Invasive Breast Carcinoma Diagnosis: Case Report

Detalhes bibliográficos
Autor(a) principal: Mehanna, Samya Hamad
Data de Publicação: 2023
Outros Autores: Linhares, Julia Costa, Santos, Emily Karoline Araujo Nonato Dos, Cavalcanti, Teresa Cristina
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Revista Brasileira de Cancerologia (Online)
Texto Completo: https://rbc.inca.gov.br/index.php/revista/article/view/4212
Resumo: Introduction: Breast carcinomas are the major cause of death in women with cancer worldwide, mainly in metastatic cases. The pituitary gland stands for only 6-8% of the secondary sites of distant metastasis and it is usually asymptomatic. When symptomatic, these lesions can mimic primary pituitary diseases. Case report: A 43-year-old woman underwent a left mastectomy with axillary lymph node dissection in April 2013 due to a luminal, invasive ductal carcinoma with nodal metastasis. Six years later, she started complaining of myalgia, bone pain, dizziness and decreased visual acuity, in addition to polydipsia and polyuria. Laboratory tests showed hyperprolactinemia and diabetes insipidus suggestive of panhypopituitarism. Magnetic resonance imaging of the brain showed a sellar tumor with extension to adjacent structures which was removed on November 2019. A pathology report of an epithelial neoplasm of unknown origin and an immunohistochemical study showed positivity for estrogen, progesterone receptors and GATA 3, and negativity for pituitary hormones. This set of findings and the histological morphology were consistent with a metastatic mucinous adenocarcinoma of mammary origin without HER-2 overexpression. The patient underwent ovarian ablation, central nervous system radiotherapy, chemotherapy and oncological follow-up. Conclusion: The patient's young age and clinical presentation of visual impairment and sudden development of diabetes insipidus diverges from the current data, since these findings are usually present in asymptomatic women over sixty-years-old. The varied clinical presentation can lead to a delay in diagnosis of pituitary metastasis, which reinforces the importance of reporting cases like this.
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spelling Pituitary Metastasis Clinical Presentation of Diabetes Insipidus Six Years after Invasive Breast Carcinoma Diagnosis: Case ReportPresentación Clínica de Metástasis Hipofisaria con Diabetes Insípida Seis Años después del Diagnóstico de Carcinoma Mamario Invasivo: Informe de CasoApresentação Clínica de Metástase Hipofisária com Diabetes Insipidus Seis Anos após o Diagnóstico de Carcinoma Mamário Invasivo: Relato de Casobreast neoplasmshypopituitarismneoplasm metastasisneoplasias da mamahipopituitarismometástase neoplásicaneoplasias de la mamahipopituitarismometástasis de la neoplasiaIntroduction: Breast carcinomas are the major cause of death in women with cancer worldwide, mainly in metastatic cases. The pituitary gland stands for only 6-8% of the secondary sites of distant metastasis and it is usually asymptomatic. When symptomatic, these lesions can mimic primary pituitary diseases. Case report: A 43-year-old woman underwent a left mastectomy with axillary lymph node dissection in April 2013 due to a luminal, invasive ductal carcinoma with nodal metastasis. Six years later, she started complaining of myalgia, bone pain, dizziness and decreased visual acuity, in addition to polydipsia and polyuria. Laboratory tests showed hyperprolactinemia and diabetes insipidus suggestive of panhypopituitarism. Magnetic resonance imaging of the brain showed a sellar tumor with extension to adjacent structures which was removed on November 2019. A pathology report of an epithelial neoplasm of unknown origin and an immunohistochemical study showed positivity for estrogen, progesterone receptors and GATA 3, and negativity for pituitary hormones. This set of findings and the histological morphology were consistent with a metastatic mucinous adenocarcinoma of mammary origin without HER-2 overexpression. The patient underwent ovarian ablation, central nervous system radiotherapy, chemotherapy and oncological follow-up. Conclusion: The patient's young age and clinical presentation of visual impairment and sudden development of diabetes insipidus diverges from the current data, since these findings are usually present in asymptomatic women over sixty-years-old. The varied clinical presentation can lead to a delay in diagnosis of pituitary metastasis, which reinforces the importance of reporting cases like this.Introducción: Los carcinomas de mama son la principal causa de muerte en mujeres con cáncer en todo el mundo, principalmente en casos metastásicos. La glándula pituitaria representa solo el 6-8% de los sitios secundarios de metástasis a distancia y generalmente es asintomática. Cuando son sintomáticas, estas lesiones pueden imitar enfermedades pituitarias primarias. Informe de caso: Mujer, 43 años, se sometió a una mastectomía izquierda con disección de ganglios linfáticos axilares en abril de 2013 debido a un carcinoma de mama ductal invasivo luminal con metástasis ganglionar. Seis años después, comenzó a quejarse de mialgia, dolor óseo, mareos y disminución de la agudeza visual, además de polidipsia y poliuria. Los análisis de laboratorio revelaron hiperprolactinemia y diabetes insípida, lo que sugiere un cuadro de panhipopituitarismo. La resonancia magnética cerebral mostró un tumor de la silla turca con extensión a estructuras adyacentes, que se extirpó en noviembre de 2019. Un informe patológico indicó una neoplasia epitelial de origen desconocido, y ha sido necesario un estudio inmunohistoquímico para dilucidar, que se mostró positivo para los receptores de estrógeno, progesterona y GATA 3, y negativo para las hormonas pituitarias. Este conjunto de hallazgos y la morfología histológica fueron consistentes con un adenocarcinoma mucinoso metastásico de origen mamario sin superexpresión de HER-2. La paciente se sometió a ablación ovárica, radioterapia del sistema nervioso central, quimioterapia y seguimiento oncológico. Conclusión: La edad de la paciente y la presentación clínica de deterioro visual y desarrollo repentino de diabetes insípida difieren de los datos actuales, ya que estos hallazgos suelen estar presentes en mujeres asintomáticas mayores de 60 años. Una variada presentación clínica puede retrasar el diagnóstico de metástasis pituitaria, lo que refuerza la importancia de informar casos como este.Introdução: O carcinoma mamário é a maior causa de morte por câncer em mulheres no mundo, majoritariamente nos casos metastáticos. A hipófise configura apenas 6-8% dos sítios metastáticos a distância, e geralmente são assintomáticos. Quando sintomáticos, podem mimetizar uma doença primária dessa glândula. Relato do caso: Mulher, 43 anos, submetida à mastectomia com esvaziamento axilar à esquerda em abril de 2013 por carcinoma mamário ductal invasivo, luminal, com metástase linfonodal. Seis anos depois, iniciou com queixa de mialgia, dor óssea, tontura e piora progressiva de acuidade visual, além de polidipsia e poliúria. Exames laboratoriais evidenciaram hiperprolactinemia e diabetes insipidus sugerindo pan-hipopituitarismo. A ressonância magnética de encéfalo demonstrou tumor selar com extensão a estruturas adjacentes que foi ressecado em novembro de 2019, com laudo de neoplasia epitelial de origem indeterminada, sendo necessário estudo imuno-histoquímico para elucidação diagnóstica. Houve positividade para o receptor de estrógeno, progesterona e GATA 3 e negatividade para hormônios hipofisários. Esse conjunto de achados e a morfologia histológica foram condizentes com adenocarcinoma mucinoso metastático de origem mamária, sem hiperexpressão de HER-2. A paciente foi submetida à ablação ovariana, radioterapia em sistema nervoso central, quimioterapia e a acompanhamento oncológico. Conclusão: A idade, a apresentação clínica de comprometimento visual e o desenvolvimento de diabetes insipidus repentino destoam dos dados da literatura, uma vez que estes costumam estar associados a mulheres acima dos 60 anos e assintomáticas. Essa apresentação clínica diversificada pode levar a um atraso no diagnóstico da metástase hipofisária, o que reforça a importância de relatar casos como este.INCA2023-10-03info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionRelato de Casoapplication/pdftext/htmlhttps://rbc.inca.gov.br/index.php/revista/article/view/421210.32635/2176-9745.RBC.2023v69n4.4212Revista Brasileira de Cancerologia; Vol. 69 No. 4 (2023): oct./nov./dec.; e-064212Revista Brasileira de Cancerologia; Vol. 69 Núm. 4 (2023): oct./nov./dic.; e-064212Revista Brasileira de Cancerologia; v. 69 n. 4 (2023): out./nov./dez.; e-0642122176-9745reponame:Revista Brasileira de Cancerologia (Online)instname:Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA)instacron:INCAenghttps://rbc.inca.gov.br/index.php/revista/article/view/4212/3217https://rbc.inca.gov.br/index.php/revista/article/view/4212/3255Copyright (c) 2023 Revista Brasileira de Cancerologiahttps://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessMehanna, Samya HamadLinhares, Julia CostaSantos, Emily Karoline Araujo Nonato DosCavalcanti, Teresa Cristina2023-12-22T14:32:18Zoai:rbc.inca.gov.br:article/4212Revistahttps://rbc.inca.gov.br/index.php/revistaPUBhttps://rbc.inca.gov.br/index.php/revista/oairbc@inca.gov.br0034-71162176-9745opendoar:2023-12-22T14:32:18Revista Brasileira de Cancerologia (Online) - Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA)false
dc.title.none.fl_str_mv Pituitary Metastasis Clinical Presentation of Diabetes Insipidus Six Years after Invasive Breast Carcinoma Diagnosis: Case Report
Presentación Clínica de Metástasis Hipofisaria con Diabetes Insípida Seis Años después del Diagnóstico de Carcinoma Mamario Invasivo: Informe de Caso
Apresentação Clínica de Metástase Hipofisária com Diabetes Insipidus Seis Anos após o Diagnóstico de Carcinoma Mamário Invasivo: Relato de Caso
title Pituitary Metastasis Clinical Presentation of Diabetes Insipidus Six Years after Invasive Breast Carcinoma Diagnosis: Case Report
spellingShingle Pituitary Metastasis Clinical Presentation of Diabetes Insipidus Six Years after Invasive Breast Carcinoma Diagnosis: Case Report
Mehanna, Samya Hamad
breast neoplasms
hypopituitarism
neoplasm metastasis
neoplasias da mama
hipopituitarismo
metástase neoplásica
neoplasias de la mama
hipopituitarismo
metástasis de la neoplasia
title_short Pituitary Metastasis Clinical Presentation of Diabetes Insipidus Six Years after Invasive Breast Carcinoma Diagnosis: Case Report
title_full Pituitary Metastasis Clinical Presentation of Diabetes Insipidus Six Years after Invasive Breast Carcinoma Diagnosis: Case Report
title_fullStr Pituitary Metastasis Clinical Presentation of Diabetes Insipidus Six Years after Invasive Breast Carcinoma Diagnosis: Case Report
title_full_unstemmed Pituitary Metastasis Clinical Presentation of Diabetes Insipidus Six Years after Invasive Breast Carcinoma Diagnosis: Case Report
title_sort Pituitary Metastasis Clinical Presentation of Diabetes Insipidus Six Years after Invasive Breast Carcinoma Diagnosis: Case Report
author Mehanna, Samya Hamad
author_facet Mehanna, Samya Hamad
Linhares, Julia Costa
Santos, Emily Karoline Araujo Nonato Dos
Cavalcanti, Teresa Cristina
author_role author
author2 Linhares, Julia Costa
Santos, Emily Karoline Araujo Nonato Dos
Cavalcanti, Teresa Cristina
author2_role author
author
author
dc.contributor.author.fl_str_mv Mehanna, Samya Hamad
Linhares, Julia Costa
Santos, Emily Karoline Araujo Nonato Dos
Cavalcanti, Teresa Cristina
dc.subject.por.fl_str_mv breast neoplasms
hypopituitarism
neoplasm metastasis
neoplasias da mama
hipopituitarismo
metástase neoplásica
neoplasias de la mama
hipopituitarismo
metástasis de la neoplasia
topic breast neoplasms
hypopituitarism
neoplasm metastasis
neoplasias da mama
hipopituitarismo
metástase neoplásica
neoplasias de la mama
hipopituitarismo
metástasis de la neoplasia
description Introduction: Breast carcinomas are the major cause of death in women with cancer worldwide, mainly in metastatic cases. The pituitary gland stands for only 6-8% of the secondary sites of distant metastasis and it is usually asymptomatic. When symptomatic, these lesions can mimic primary pituitary diseases. Case report: A 43-year-old woman underwent a left mastectomy with axillary lymph node dissection in April 2013 due to a luminal, invasive ductal carcinoma with nodal metastasis. Six years later, she started complaining of myalgia, bone pain, dizziness and decreased visual acuity, in addition to polydipsia and polyuria. Laboratory tests showed hyperprolactinemia and diabetes insipidus suggestive of panhypopituitarism. Magnetic resonance imaging of the brain showed a sellar tumor with extension to adjacent structures which was removed on November 2019. A pathology report of an epithelial neoplasm of unknown origin and an immunohistochemical study showed positivity for estrogen, progesterone receptors and GATA 3, and negativity for pituitary hormones. This set of findings and the histological morphology were consistent with a metastatic mucinous adenocarcinoma of mammary origin without HER-2 overexpression. The patient underwent ovarian ablation, central nervous system radiotherapy, chemotherapy and oncological follow-up. Conclusion: The patient's young age and clinical presentation of visual impairment and sudden development of diabetes insipidus diverges from the current data, since these findings are usually present in asymptomatic women over sixty-years-old. The varied clinical presentation can lead to a delay in diagnosis of pituitary metastasis, which reinforces the importance of reporting cases like this.
publishDate 2023
dc.date.none.fl_str_mv 2023-10-03
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
Relato de Caso
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://rbc.inca.gov.br/index.php/revista/article/view/4212
10.32635/2176-9745.RBC.2023v69n4.4212
url https://rbc.inca.gov.br/index.php/revista/article/view/4212
identifier_str_mv 10.32635/2176-9745.RBC.2023v69n4.4212
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv https://rbc.inca.gov.br/index.php/revista/article/view/4212/3217
https://rbc.inca.gov.br/index.php/revista/article/view/4212/3255
dc.rights.driver.fl_str_mv Copyright (c) 2023 Revista Brasileira de Cancerologia
https://creativecommons.org/licenses/by/4.0
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright (c) 2023 Revista Brasileira de Cancerologia
https://creativecommons.org/licenses/by/4.0
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
text/html
dc.publisher.none.fl_str_mv INCA
publisher.none.fl_str_mv INCA
dc.source.none.fl_str_mv Revista Brasileira de Cancerologia; Vol. 69 No. 4 (2023): oct./nov./dec.; e-064212
Revista Brasileira de Cancerologia; Vol. 69 Núm. 4 (2023): oct./nov./dic.; e-064212
Revista Brasileira de Cancerologia; v. 69 n. 4 (2023): out./nov./dez.; e-064212
2176-9745
reponame:Revista Brasileira de Cancerologia (Online)
instname:Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA)
instacron:INCA
instname_str Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA)
instacron_str INCA
institution INCA
reponame_str Revista Brasileira de Cancerologia (Online)
collection Revista Brasileira de Cancerologia (Online)
repository.name.fl_str_mv Revista Brasileira de Cancerologia (Online) - Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA)
repository.mail.fl_str_mv rbc@inca.gov.br
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