ABSTRACT
Non-functioning pituitary adenoma (NFPA) with higher proliferation index (WHO II) are often a therapeutical challenge. Low somatostatin receptor expression in these tumors usually prevents a treatment with somatostatin analogs. In 1996, a 55-year-old patient was referred due to right-sided headache. A pituitary macroadenoma with infiltration into the right cavernous sinus was diagnosed. There was no visual field deficit and the clinical and biochemical work up was consistent with a NFPA. The patient underwent transsphenoidal surgery. Residual adenoma remained in the right cavernous sinus. Histologically, a null-cell adenoma with a high proliferation index was documented (MIB-1: 11.6%, WHO II). Somatostatin receptor autoradiography was performed in the surgical specimen showing a homogenous expression of sst2 receptors. Radiosurgery was completed with stable disease for 8 years. In 2004, the patient was diagnosed with an incomplete palsy of the right oculomotorius nerve and a significant increase in the volume of the adenoma in the right cavernous sinus. After a positive Octreoscan(®) the patient consented to an experimental therapy approach using Lutetium DOTATOC (3 × 200 mCi). The palsy of the oculomotorius nerve improved and remained stable until today (March 2013), the follow-up MRI scans demonstrated stable disease. This is the first case of a patient with a NFPA (WHO II) in whom PRRT successfully improved the local complications of the tumor for more than 8 years after ineffective surgery and gamma knife therapy. The determination of sst2 in vitro using autoradiography and in vivo by Octreoscan was instrumental to administer this therapy in a challenging situation.
Subject(s)
Pituitary Neoplasms/radiotherapy , Radiopharmaceuticals/therapeutic use , Receptors, Peptide/drug effects , Adult , Combined Modality Therapy , Humans , Male , Octreotide/analogs & derivatives , Octreotide/therapeutic use , Ophthalmoplegia/etiology , Ophthalmoplegia/radiotherapy , Pituitary Neoplasms/surgery , Receptors, Somatostatin/drug effects , Receptors, Somatostatin/radiation effects , Somatostatin/analogs & derivativesSubject(s)
Breast Neoplasms , Ophthalmoplegia , Aged, 80 and over , Brain , Breast Neoplasms/complications , Breast Neoplasms/drug therapy , Breast Neoplasms/physiopathology , Breast Neoplasms/radiotherapy , Cranial Fossa, Posterior/diagnostic imaging , Cranial Fossa, Posterior/physiopathology , Female , Humans , Magnetic Resonance Imaging , Neoplasm Metastasis/diagnosis , Neoplasm Metastasis/radiotherapy , Ophthalmoplegia/complications , Ophthalmoplegia/diagnosis , Ophthalmoplegia/physiopathology , Ophthalmoplegia/radiotherapy , RadiographyABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Exophthalmos/diagnostic imaging , Abducens Nerve/diagnostic imaging , Neoplasm Metastasis/diagnosis , Skull Base/diagnostic imaging , Ophthalmoplegia/diagnostic imaging , Ophthalmoplegia/radiotherapy , Exophthalmos/complications , Skull Base/injuries , Skull Base/pathology , Oculomotor Nerve Diseases/diagnostic imaging , Oculomotor Nerve Diseases/radiotherapyABSTRACT
A case of a 60-year-old man with metastatic adenocarcinoma of the colon who developed bilateral ophthalmoplegia acutely is presented. Bilateral cavernous sinus metastasis was suggested by magnetic resonance imaging and proven by endoscopic sphenoidal biopsy. The patient was treated with radiotherapy (2000 cGy) with near resolution of his symptoms. This patient represents the first reported case of acute bilateral ophthalmoplegia resulting from hematogenous metastasis to both cavernous sinuses, diagnosed antemortem. A review of the more common causes of acute bilateral ophthalmoplegia is presented.
Subject(s)
Adenocarcinoma/secondary , Cavernous Sinus/pathology , Colonic Neoplasms/pathology , Cranial Nerve Neoplasms/secondary , Dominance, Cerebral/physiology , Ophthalmoplegia/etiology , Sphenoid Sinus/pathology , Adenocarcinoma/pathology , Adenocarcinoma/radiotherapy , Biopsy , Colonic Neoplasms/radiotherapy , Cranial Irradiation , Cranial Nerve Neoplasms/pathology , Cranial Nerve Neoplasms/radiotherapy , Diagnosis, Differential , Humans , Male , Middle Aged , Ophthalmoplegia/pathology , Ophthalmoplegia/radiotherapyABSTRACT
The authors have analysed a case of Tolosa-Hunt syndrome with a persistent recurring course and a gradual development of resistance to steroid therapy. Computerized tomography revealed a high density zone in the affected cavernous sinus of the patient. Differential diagnosis between a tumor and Tolosa-Hunt syndrome was made. The patient received 3 fractions of proton beam irradiation by the "piercing" method (the beam being 15 mm in diameter) at a dose of 60 Gy. After irradiation computerized tomography showed complete recovery of disturbed functions and disappearance of the focus. Four-year remission was observed. In our experience, it was the first case of the use of radiation therapy in Tolosa-Hunt syndrome.
Subject(s)
Ophthalmoplegia/radiotherapy , Protons , Radiotherapy, High-Energy , Adult , Cavernous Sinus/radiation effects , Humans , MaleABSTRACT
A patient with advanced severe mycosis fungoides presented several unusual features, including prominent lesions of the palate and tongue and an orbital tumor with exophthalmos and ophthalmoplegia. A hitherto undescribed feature was the development of multiple, massive subcutaneous tumors unrelated to the dermis or to lymph nodes, and large tumors in the connective tissues of the buttock, flank, and retroperitoneum. The usual sites of extracutaneous dissemination of mycosis fungoides--lymph nodes, spleen, liver, lungs, and blood--were not demonstrably involved. This may be a new pattern of dissemination for this disease. Of practical importance is the immediate and complete relief of exophthalmos and ophthalmoplegia that was obtained with emergency radiotherapy.