Rare Pituitary Metastasis from Adenocarcinoma of Right Lung in 18F FDG PET/CT

Srijani Mandal; T. Kishan Subudhi; Santosh C. Kannur; Girish Kumar Parida; Manoj Kumar Nayak; P. Sai Sradha Patro; Kanhaiyalal Agrawal

doi:10.4103/ijnm.ijnm_25_25

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40 (

); 178-180

doi:

10.4103/ijnm.ijnm_25_25

Rare Pituitary Metastasis from Adenocarcinoma of Right Lung in ¹⁸F FDG PET/CT

Srijani Mandal, T. Kishan Subudhi^,, Santosh C. Kannur, Girish Kumar Parida, Manoj Kumar Nayak¹, P. Sai Sradha Patro, Kanhaiyalal Agrawal

Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

1Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Address for correspondence: Dr. T. Kishan Subudhi, Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar - 751 019, Odisha, India. E-mail: kishansubudhi90@gmail.com

Received: 2025-02-21, Accepted: 2025-05-17, Published: 2025-08

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This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Lung cancer is the leading cause of cancer and cancer-related deaths, and India ranks the fourth highest country. Lung cancer is a highly aggressive malignancy with a tendency for rapid progression, making early detection and prompt treatment essential for improving patient outcomes. Lung cancer can spread locally into surrounding tissue as well as travel through lymphatics to other parts of the body, most often to bone, brain, liver, and adrenal glands. Metastasis to pituitary and pineal glands is extremely rare. The differential diagnosis for pituitary metastasis could be pituitary adenoma where lesion usually lies at the anterior aspect of pituitary fossa, whereas metastasis is seen at the posterior aspect. There is a paucity of published literature, with only a few cases reported of pituitary and pineal gland metastasis. Hence, to add to the literature, we present a case of pituitary metastasis in an older woman with lung cancer.

Keywords

Adenocarcinoma

18F flurodeoxyglucose positron emission tomography/computed tomography

pineal gland metastasis

pituitary gland metastasis

Show Related Articles from PubMed

A 50-year-old female from a rural village in India presented with bilateral cervical swelling and cough for 4 months. On biopsy from the right supraclavicular lymph node, it showed metastatic adenocarcinoma from lung origin. She had no smoking history and was known hypertensive on medication for 4 years. Flurodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) done as initial workup [Figure 1], showed FDG avid primary right lung lesion with bilateral supraclavicular and mediastinal lymph nodes and liver and skeletal lesions. The patient was started on pembrolizumab (PDL-1 inhibitor) and chemotherapy comprising paclitaxel and carboplatin. FDG PET/CT done after 3 cycles of treatment [Figure 2] for response assessment, showed progressive disease along with brain metastasis to pituitary gland [Figure 3]. Further patient was advised magnetic resonance imaging (MRI) brain for confirmation, which showed multiple hyperintense brain lesions, including lesions at pituitary and additional pineal gland at T2W/fluid-attenuated inversion recovery (FLAIR) MRI imaging [Figure 4].

Pretherapy max intensity projection image of flurodeoxyglucose (FDG)-positron emission tomography computed tomography (base of skull–thigh) scan shows FDG-avid right lung lesion with bilateral supraclavicular and mediastinal lymph nodes and liver and skeletal lesions

Posttherapy max intensity projection image of flurodeoxyglucose (FDG)-positron emission tomography computed tomography (base of skull–thigh) scan shows frank increase in FDG avid lesions, denoting progressive disease

(a and b) Sagittal sections computed tomography (CT) brain and fused positron emission tomography (PET)/CT shows soft tissue lesion at pituitary fossa with increased flurodeoxyglucose (FDG) uptake. (c and d) Axial sections CT brain and fused PET/CT show soft tissue lesion at pituitary fossa with increased FDG uptake

Sagittal section of T2W/fluid-attenuated inversion recovery magnetic resonance imaging shows enhancing lesions at posterior part of pituitary gland (blue arrow) and pineal gland (green arrow)

Lung cancer is the leading cause of cancer and cancer-related deaths, and India ranks the fourth highest country.[1] Small cell lung cancer have shown maximum propensity to metastasize to the brain at the initial diagnosis compared to non small cell varieties.[2] However, pituitary metastasis is rare and shows poor signifies.[3] Pituitary adenoma, in which the lesion often occurs at the anterior aspect of the pituitary fossa while metastasis is observed at the posterior aspect, could be the differential diagnosis for pituitary metastasis.[4]

According to literature few cases of pituitary metastasis have been published.[5 6 7 8 9 10 11] and accounts for <1% of all intracranial metastasis.[9] A rare case of pineal gland metastases has been found from adenocarcinoma lung.[12] Biopsy is a method of diagnosis, but being intracranial difficult to perform and could be hazardous to the patient as well. Henceforth, imaging technique MRI as well as PET/CT can be used for detecting metastatic spread including at brain.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Conflicts of interest

There are no conflicts of interest.

Nil.

References

Deshpand R, Chandra M, Rauthan A. Evolving trends in lung cancer: Epidemiology, diagnosis, and management. Indian J Cancer. 2022;59:S90-105.
[Google Scholar]
Smith DR, Bian Y, Wu CC, Saraf A, Tai CH, Nanda T, . Natural history, clinical course and predictors of interval time from initial diagnosis to development of subsequent NSCLC brain metastases. J Neurooncol. 2019;143:145-55.
[Google Scholar]
Henry A, Nugent A, Wallace IR, Oladipo B, Sheehy O, Johnston PC. Pituitary metastasis: A clinical overview. Ulster Med J. 2021;90:146-50.
[Google Scholar]
Max MB, Deck MD, Rottenberg DA. Pituitary metastasis: incidence in cancer patients and clinical differentiation from pituitary adenoma. Neurology. 1981;31:998-1002.
[Google Scholar]
Kilbane Myers J, Abdelrahman A, Akpunonu B. Lung cancer metastasis to the pituitary gland. Cureus. 2022;14:e22608.
[Google Scholar]
Komninos J, Vlassopoulou V, Protopapa D, Korfias S, Kontogeorgos G, Sakas DE, . Tumors metastatic to the pituitary gland: Case report and literature review. J Clin Endocrinol Metab. 2004;89:574-80.
[Google Scholar]
Asim SA, Elashaal AA. Metastasis of lung adenocarcinoma to the pituitary gland. Radiol Case Rep. 2023;18:3487-91.
[Google Scholar]
Alhashem A, Taha M, Almomen A. Pituitary metastasis of lung adenocarcinoma: Case report and literature review. Int J Surg Case Rep. 2020;67:98-101.
[Google Scholar]
Lopes AM, Pereira J, Ribeiro I, Martins da Silva A, Queiroga H, Amaral C. Pituitary metastasis unveiling a lung adenocarcinoma. Endocrinol Diabetes Metab Case Rep. 2021;2021:20-0211.
[Google Scholar]
Amaral S, Matias A, Bouça B, Manique I, Palha A, Cortez L, . Pituitary metastasis as the first manifestation of lung carcinoma. Clin Case Rep. 2022;10:e6601.
[Google Scholar]
Castle-Kirszbaum M, Goldschlager T, Ho B, Wang YY, King J. Twelve cases of pituitary metastasis: A case series and review of the literature. Pituitary. 2018;21:463-73.
[Google Scholar]
Gaillard F, Jones J. Masses of the pineal region: Clinical presentation and radiographic features. Postgrad Med J. 2010;86:597-607.
[Google Scholar]

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[1] Deshpand R, Chandra M, Rauthan A. Evolving trends in lung cancer: Epidemiology, diagnosis, and management. Indian J Cancer. 2022;59:S90-105.
[Google Scholar]

[2] Smith DR, Bian Y, Wu CC, Saraf A, Tai CH, Nanda T, . Natural history, clinical course and predictors of interval time from initial diagnosis to development of subsequent NSCLC brain metastases. J Neurooncol. 2019;143:145-55.
[Google Scholar]

[3] Henry A, Nugent A, Wallace IR, Oladipo B, Sheehy O, Johnston PC. Pituitary metastasis: A clinical overview. Ulster Med J. 2021;90:146-50.
[Google Scholar]

[4] Max MB, Deck MD, Rottenberg DA. Pituitary metastasis: incidence in cancer patients and clinical differentiation from pituitary adenoma. Neurology. 1981;31:998-1002.
[Google Scholar]

[5] Kilbane Myers J, Abdelrahman A, Akpunonu B. Lung cancer metastasis to the pituitary gland. Cureus. 2022;14:e22608.
[Google Scholar]

[6] Komninos J, Vlassopoulou V, Protopapa D, Korfias S, Kontogeorgos G, Sakas DE, . Tumors metastatic to the pituitary gland: Case report and literature review. J Clin Endocrinol Metab. 2004;89:574-80.
[Google Scholar]

[7] Asim SA, Elashaal AA. Metastasis of lung adenocarcinoma to the pituitary gland. Radiol Case Rep. 2023;18:3487-91.
[Google Scholar]

[8] Alhashem A, Taha M, Almomen A. Pituitary metastasis of lung adenocarcinoma: Case report and literature review. Int J Surg Case Rep. 2020;67:98-101.
[Google Scholar]

[9] Lopes AM, Pereira J, Ribeiro I, Martins da Silva A, Queiroga H, Amaral C. Pituitary metastasis unveiling a lung adenocarcinoma. Endocrinol Diabetes Metab Case Rep. 2021;2021:20-0211.
[Google Scholar]

[10] Amaral S, Matias A, Bouça B, Manique I, Palha A, Cortez L, . Pituitary metastasis as the first manifestation of lung carcinoma. Clin Case Rep. 2022;10:e6601.
[Google Scholar]

[11] Castle-Kirszbaum M, Goldschlager T, Ho B, Wang YY, King J. Twelve cases of pituitary metastasis: A case series and review of the literature. Pituitary. 2018;21:463-73.
[Google Scholar]

[12] Gaillard F, Jones J. Masses of the pineal region: Clinical presentation and radiographic features. Postgrad Med J. 2010;86:597-607.
[Google Scholar]