Pituitary mass with cerebrospinal fluid seeding: A rare presentation of probable pituitary carcinoma: A case report.

Abstract

Introduction:

 Pituitary carcinomas (PCs) are exceptionally rare neoplasms (0.1–0.2% of pituitary tumors), defined by metastatic spread and typically diagnosed in older adults. Presentation in adolescence is extraordinarily uncommon, and radiological evidence of cerebrospinal fluid (CSF) dissemination before histopathological confirmation is even rarer.

Case Presentation:

 This case report discusses a 15-year-old female with hyperprolactinemia and progressive visual blurring. Contrast-enhanced MRI revealed a large (35 × 17 × 20 mm) hour-glass-shaped sellar mass with suprasellar extension, bilateral internal carotid artery encasement, and multiple enhancing nodular deposits in the ambient cisterns, findings consistent with a locally aggressive pituitary neoplasm and probable CSF dissemination.

Conclusion: 

This case illustrates that pituitary carcinoma, though rare, should be considered in adolescents when MRI demonstrates aggressive features such as arterial encasement and leptomeningeal nodules. Early recognition of these imaging red flags is critical to expedite histopathological diagnosis and initiate multidisciplinary management.

Take Away Lessons:

 (i) Hour-glass morphology and carotid encasement in a pediatric pituitary mass warrant suspicion for malignancy; (ii) Nodular CSF deposits in the ambient cisterns are highly suggestive of metastatic dissemination; (iii) MRI provides non-invasive clues that can guide timely biopsy and targeted therapy; (iv) Multidisplinary approach including counselling is required to thwart and or demisify cultral beliefs that may be a barrier to early diagnosis and treatment.