Pituitary carcinoma containing gonadotropins: Treatment by radical excision and cytotoxic chemotherapy: Case report

OBJECTIVE AND IMPORTANCE: Pituitary carcinomas are extremely rare. Cases re ported in the medical literature in the 20th century included tumors that p roduced adrenocorticotropic hormone, prolactin, growth hormone, and/or thyr otropin. CLINICAL PRESENTATION: Here we present a 22-year-old woman with a pituitary carcinoma that was immunohistochemically positive for luteinizing hormone and follicle-stimulating hormone at both the primary and metastatic sites. The patient exhibited elevated serum levels of alpha-subunit. INTERVENTION: The patient had experienced failure of previous treatments, i ncluding standard surgery and radiotherapy, and presented to us for radical resection of the tumor, with exenteration of the involved cavernous sinus. She was pretreated with cytotoxic chemotherapy and continued to receive th is therapy after surgery. CONCLUSION: This is the only documented case of a gonadotropin-staining pit uitary carcinoma for which hormone production was proven in both the primar y and metastatic tumors. Many benign "nonsecreting" pituitary adenomas actu ally produce subclinical amounts of gonadotropins, and malignant nonfunctio nal pituitary neoplasms may do the same.