Malignant prolactinoma - Case report and review of the literature

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.