浸润性乳腺癌诊断后6年尿崩症患者垂体转移的临床表现:1例报告

Samya Hamad Mehanna, Julia Costa Linhares, Emily Karoline Araujo Nonato Dos Santos, Teresa Cristina Cavalcanti
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引用次数: 0

摘要

简介:乳腺癌是世界范围内女性癌症患者死亡的主要原因,主要是转移性病例。垂体仅占远处转移继发部位的6-8%,通常无症状。当有症状时,这些病变可模拟原发性垂体疾病。病例报告:2013年4月,一名43岁女性因腔内浸润性导管癌伴淋巴结转移行左乳房切除术并腋窝淋巴结清扫。六年后,她开始抱怨肌肉痛、骨痛、头晕、视力下降,此外还有渴饮和多尿。实验室检查显示高催乳素血症和尿崩症提示全垂体功能低下。脑部磁共振成像显示一个鞍区肿瘤,并扩展到邻近结构,于2019年11月切除。一份来源不明的上皮肿瘤的病理报告和免疫组织化学研究显示雌激素、孕激素受体和GATA 3阳性,垂体激素阴性。这组结果和组织学形态符合乳腺源性转移性粘液腺癌,没有HER-2过表达。患者行卵巢消融术、中枢神经系统放疗、化疗及肿瘤随访。结论:患者的年龄和视力损害及突发性尿崩症的临床表现与目前的资料不同,因为这些表现通常出现在60岁以上无症状的女性中。不同的临床表现可能导致垂体转移的诊断延迟,这加强了报告此类病例的重要性。
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Pituitary Metastasis Clinical Presentation of Diabetes Insipidus Six Years after Invasive Breast Carcinoma Diagnosis: Case Report
Introduction: Breast carcinomas are the major cause of death in women with cancer worldwide, mainly in metastatic cases. The pituitary gland stands for only 6-8% of the secondary sites of distant metastasis and it is usually asymptomatic. When symptomatic, these lesions can mimic primary pituitary diseases. Case report: A 43-year-old woman underwent a left mastectomy with axillary lymph node dissection in April 2013 due to a luminal, invasive ductal carcinoma with nodal metastasis. Six years later, she started complaining of myalgia, bone pain, dizziness and decreased visual acuity, in addition to polydipsia and polyuria. Laboratory tests showed hyperprolactinemia and diabetes insipidus suggestive of panhypopituitarism. Magnetic resonance imaging of the brain showed a sellar tumor with extension to adjacent structures which was removed on November 2019. A pathology report of an epithelial neoplasm of unknown origin and an immunohistochemical study showed positivity for estrogen, progesterone receptors and GATA 3, and negativity for pituitary hormones. This set of findings and the histological morphology were consistent with a metastatic mucinous adenocarcinoma of mammary origin without HER-2 overexpression. The patient underwent ovarian ablation, central nervous system radiotherapy, chemotherapy and oncological follow-up. Conclusion: The patient's young age and clinical presentation of visual impairment and sudden development of diabetes insipidus diverges from the current data, since these findings are usually present in asymptomatic women over sixty-years-old. The varied clinical presentation can lead to a delay in diagnosis of pituitary metastasis, which reinforces the importance of reporting cases like this.
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