An unusual pituitary stalk lesion: What is the place of surgery?

Neurochirurgie. 2016 Dec;62(6):339-343. doi: 10.1016/j.neuchi.2016.08.002. Epub 2016 Oct 26.

Abstract

Background: Sellar and suprasellar primary melanocytic tumors are exceptional occurrences. Besides the difficulty of differential diagnosis between a primary and secondary lesion, treatment of these pathologies is still unclear and controversial.

Case report: We describe the case of a 36-year-old woman with no relevant previous medical history who presented with 1 month history of diabetes insipidus, blurred vision and generalized weakness; a brain MRI disclosed an atypical pituitary stalk lesion; initially the tumor was biopsied through an endonasal endoscopic approach that revealed a melanocytic tumor; the patient was afterwards managed by a second stage extended endonasal endoscopic approach achieving a subtotal tumor removal. The overall survival was of 14 months due to the multidisciplinary management including surgery, radio and chemotherapy.

Conclusion: If a biopsy is essential to deal with these invasive lesions, treatment including surgical resection should be part of a multidisciplinary approach.

Keywords: Melanoma; Pituitary; Sellar; Sellar melanocytic tumor.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antineoplastic Agents / therapeutic use
  • Combined Modality Therapy
  • Cranial Irradiation
  • Dacarbazine / analogs & derivatives
  • Dacarbazine / therapeutic use
  • Diabetes Insipidus / etiology
  • Endoscopy / methods*
  • Fatal Outcome
  • Female
  • Hemianopsia / etiology
  • Humans
  • Hypopituitarism / etiology
  • Indoles / therapeutic use
  • Melanoma / complications
  • Melanoma / diagnosis
  • Melanoma / diagnostic imaging
  • Melanoma / surgery*
  • Pituitary Neoplasms / complications
  • Pituitary Neoplasms / diagnosis
  • Pituitary Neoplasms / diagnostic imaging
  • Pituitary Neoplasms / surgery*
  • Sulfonamides / therapeutic use
  • Temozolomide
  • Tomography, X-Ray Computed
  • Vemurafenib

Substances

  • Antineoplastic Agents
  • Indoles
  • Sulfonamides
  • Vemurafenib
  • Dacarbazine
  • Temozolomide