Nihar Shah1, Yana Cavanagh1, Hamid Shaaban2, Beth Stein1, Sohail N Shaikh1, Dharmesh H Kaswala3, Walid Baddoura2
1Department of Gastroenterology, St. Joseph’s Regional Medical Center, Paterson, NJ, USA.
2Department of Gastroenterology, St Michael’s Medical Center, Newark, NJ, USA.
3Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA, USA.
Sellar masses are frequently adenomatous pituitary tumors. Metastatic disease is unusual, often mimicking the presentations of adenomas. Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy but unusual to have a pituitary metastasis (PM). A 65-year-old man presented with headache, diplopia, ptosis, decreased vision in the right eye and unintentional weight loss of 32lbs. Preliminary out-patient work-up revealed a mass in the pituitary region. Cranial imaging showed 3.1 cm × 3.2 cm × 4.4 cm lesion. Abdominal imaging (computed tomography and magnetic resonance imaging) demonstrated a lobulated, nodular and heterogeneous right lobe of the liver. Trans-sphenoidal resection of the sellar mass favored metastatic HCC on histology. Liver biopsy confirmed HCC. We recommend maintaining an increased clinical suspicion upon evaluation of nonclassical clinical and radiological presentations of suspected PM/malignancy; as well as pursuing additional investigations in all early cases.
Keywords: Hepatocellular carcinoma, metastasis, pituitary gland.