Inicijalno otkrivena simptomatska metastaza u hipofizu u bolesnika s karcinomom prostate pjenušavih stanica: određivanje sigurne i efikasne terapije

Abstract

Metastases to pituitary gland are unusual and mostly asymptomatic, presenting with local symptoms in one of ten patients, and only 3%-5% of them are of prostate origin. Here we report and evaluate the effectiveness and safety of multimodal treatment in a patient with pituitary metastasis of a prostate foamy gland carcinoma. A 78-year-old male patient presented with blurred vision and headache without a previous history of malignancy. Magnetic resonance imaging scans revealed a large sellar mass, with infiltration of the surrounding structures. Maximal trans-sphenoidal reduction of pituitary metastasis was performed, with a histologic finding of metastatic prostate foamy gland adenocarcinoma. Evaluation of the prostate specific antigen revealed a very high level (1461 ng/mL) and foamy gland carcinoma was found on prostate needle biopsy. The patient received 3Dconformal external beam radiotherapy with 6 MV photons to the sellar and parasellar region with a tumor dose of 44 Gy, followed by androgen deprivation therapy. Follow up magnetic resonance imaging done after radiotherapy showed shrinkage of the tumor process, with rapid prostate specific antigen decline to 0.3 ng/mL. The visual function was fully established and headache resolved. On the last follow up 14 months after the diagnosis, the patient was alive and free from clinical signs of disease. Tailored treatment, including limited radiotherapy in a higher palliative dose, in a patient with foamy gland symptomatic pituitary metastatic disease resulted in good local and systemic control of the disease. In older male patients with clinical and/or radiologic characteristics suggestive of metastatic pituitary disease, the prostate specific antigen test should be included as part of the work-up.Metastaze u hipofizu su vrlo rijetke, a oko 3%-5% čine metastaze s ishodištem u prostati, u većini slučajeva su asimptomatske, dok su lokalni simptomi prisutni samo u jednog od deset bolesnika. Ovim slučajem prikazujemo i procjenjujemo učinkovitost i sigurnost multimodalnog liječenja u bolesnika s metastazama u hipofizu primarnog ishodišta u karcinomu prostate pjenušavih stanica. Prikazuje se 78-godišnji muškarac bez prethodne anamneze maligne bolesti kod kojega su se pojavili simptomi zamućenog vida i glavobolje. Magnetskom rezonancom je otkrivena velika selarna masa s infiltracijom okolnih struktura. Učinjena je maksimalna transfenoidna redukcija metastaze u hipofizi te je dobiven histološki nalaz metastatskog adenokarcinoma prostate pjenušavih stanica. Otkrivena je vrlo visoka vrijednost za prostatu specifičnog antigena (1461 ng/mL) te je biopsijom prostate tankom iglom dobiven nalaz karcinoma pjenušavih stanica. Bolesnik je primio 3D-konformalnu radioterapiju vanjskim snopom s fotonima energije 6 MV na selarnu i paraselarnu regiju s tumorskom dozom od 44 Gy te je nastavio primati androgenu deprivacijsku terapiju. Kontrolna snimka magnetske rezonance pokazala je smanjenje tumorskog procesa s brzim padom za prostatu specifičnog antigena na 0,3 ng/mL. Uspostavljena je potpuna vizualna funkcija s postupnim nestankom glavobolje. Na posljednjem kontrolnom pregledu 14 mjeseci nakon postavljene dijagnoze bolesnik je živ, bez kliničkih znakova bolesti. Prilagođeno liječenje bolesnika sa simptomatskom metastatskom bolesti od karcinoma pjenušavih stanica, koje uključuje ograničenu radioterapiju u višoj palijativnoj dozi, rezultiralo je dobrom lokalnom i sistemskom kontrolom bolesti. U starijih muških bolesnika s kliničkim i/ili radiološkim osobinama sa sumnjom za metastatsku bolest u hipofizu test za prostatu specifičnog antigena trebao bi biti uključen kao dio obrade

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