BACKGROUND Malignant prolactinomas are rare events. To date, only 14 patien
ts with metastases in- or outside the central nervous system have been repo
rted.
CASE DESCRIPTION We present a patient who developed a metastasis to the cau
da equina, which is the first case documented with MRI. A giant prolactinom
a in this 51-year-old man was partially removed by a transcranial approach.
After radiotherapy and treatment with bromocriptine, the patient had a rem
ission for 3 years. Thereafter, a sacral intraspinal tumor was diagnosed. B
ecause of increasing prolactin levels not responding to bromocriptine and a
radiologically suspected intrasellar tumor, we operated transsphenoidally
first and found only fibrous tissue. We performed a sacral laminectomy and
almost totally removed an intradural tumor. Histopathology and immuno-histo
chemistry confirmed the diagnosis of a prolactinoma metastasis. The patient
received radiotherapy and bromocriptine and has no evidence of recurrent t
umor or metastases after a follow-up of 38 months, thus being the second re
ported patient with long-term remission of the disease.
DISCUSSION We review the literature on this topic and try to establish comm
on features of the course of this rare malignant disease and the efficacy o
f therapy in the cases reported hitherto. (C) 1999 by Elsevier Science Inc.