Pituitary apoplexy secondary to a metastatic renal cell carcinoma. Report of a case followed for seven years

We report a man in whom a 15 cm. renal tumor was excised at the age of 49. The pathological examination showed a clear cell carcinoma. Five years late r, he presented with headache, vomiting and unilateral palpebral ptosis. Im aging studies showed a sellar tumor with pituitary apoplexy. The tumor was excised and the pathological study disclosed a clear cell tumor, positive f or vimentin, cytokeratins AE1 and AE3 and immunohistochemically negative fo r LH, TSH, ACTH and GH. Considering the similar histopathological features, it was considered as a metastasis of the renal tumor. The patient was supp lemented with thyroid, adrenal and gonadal hormones. Seven years later, he presented a new tumor in the remaining kidney, that corresponded to a cysti c papillary renal cell carcinoma. Afterwards, he presented a transitional u rinary bladder tumor. Mortality associated to renal cell tumors is 90% at 5 years, and pituitary metastases are extraordinarily uncommon (Rev Med Chil e 2000; 128: 1015-8).