[Panhypopituitarism secondary to pituitary metastases]. / Panhypopituitarisme secondaire à une métastase hypophysaire.

BACKGROUND: Hypophyseal metastatic localizations are uncommon and rarely the first expression of a primary cancer. We report an exceptional case revealed by panhypopituitarism and diabetes insipidis. CASE REPORT: Brain MRI visualized an intra- and suprasellar tumoral formation found to be a cribiform adenocarcinoma. The primary tumor could not be identified. Despite radiotherapy, surgery and chemotherapy combining carboplatin and etoposide, the tumor progressed with the development of cervical and mediastinal nodes. The patient died one year after onset of the clinical signs. DISCUSSION: Diagnosis of hypophyseal metastasis is mainly based on indirect evidence: rapid course, invasion of neighboring structures. Optimal management of these rare tumors remains to be determined.

[Long-term survival of a patient with melanoma with late recurrence of pulmonary metastasis treated by repeat surgery]. / Longue survie d'un cas de mélanome malin avec métastases pulmonaires tardives, récidivantes, traitées par chirurgie itérative.

We report the case of a young woman initially treated with surgery, radiotherapy, chemotherapy and BCG therapy for stage II malignant melanoma involving the limbs. Considering that the risk of metastasis is usually maximal between 2 and 5 years after initial treatment, metastatic dissemination of this melanoma was rather unusual. Metastases were observed locally, regionally, and in the lungs 8, 10 and 12 years respectively after the primary diagnosis. Repeat surgery was performed to resect pulmonary nodules. Such surgery is possible in less than 10% of the cases of metastatic melanoma. Our patient has survived without relapse for 21 years after the initial diagnosis and 8 years after the last tumor excision. Recurrent pulmonary metastasis without extrapulmonary dissemination would suggest the tumor cell population was composed of a particular metastatic phenotype.