Pulmonary adenocarcinoma metastatic to pituitary craniopharyngioma

Metastatic localisation of extracanial tumours inside a primary central nervous system (CNS) neoplasm is a rare, but well documented event usually involving meningiomas.^1,2 Although metastases to the sellar region are usually found in patients with advanced neoplastic disease, tumour to tumour phenomena in this site are rare and usually involve pituitary adenomas.^3,4

This report describes a case of pulmonary adenocarcinoma metastatic inside a pituitary craniopharyngioma and the associated pathological and neuroradiological findings. It also suggests an aetiopathogenetic hypothesis for this event.

A 53 year old man underwent right pulmonary bilobectomy because of a non-small cell carcinoma. Pathological examination showed a pT2 N0 pulmonary adenocarcinoma with vascular invasion. Clinical and instrumental findings were negative for metastatic disease.

Eight months later, the patient presented a visual field defect, diabetes insipidus, and headache. Cerebral computerised tomography (CT) and magnetic resonance imaging (MRI) showed an intrasuprasellar, partially cystic lesion measuring 4 cm in the craniocaudal axis (fig 1). The lesion appeared to be well demarcated, with a partially calcified wall, and presented calcifications and areas of hyperintesity that were taken for haemorrhagic areas. The neoplasm showed an intrasellar and suprasellar component, with chiasmal stretching. Preoperative neuroradiological diagnosis was …