Metastatic Tumors To The Sellar Region

Metastatic deposits from any systemic and hemopoietic malignancies occasionally involve the sellar region (1). A favored anatomic target for such deposits is the posterior lobe of the pituitary. The predilection of metastatic tumors for the posterior lobe of the pituitary relates to its blood supply. In contrast to the anterior pituitary, which has a somewhat tenuous and indirect supply from the portal circulation, the posterior lobe derives its circulation directly from the carotid arterial system. Although the majority of metastatic tumors in this region occur in the context of advanced malignancy, occasional posterior lobe metastases may be the first sign of an unrecognized neoplastic process (150,151). Of the metastatic cancers, breast is the most common primary, followed by lung and prostate (150,151). Hemopoietic malignancies that may present with a posterior lobe deposit include the solitary plasmacytomas (which usually evolve into multiple myelomas) as well as various lymphomas and leukemias (150,152). DI is often an accompanying feature, and its presence in association with a sellar mass should raise the possibility of a metastatic tumor. Additional symptoms include headache, visual field defects, hypopitu-itarism, and cranial nerve palsies related to cavernous sinus infiltration. With the exception of DI, which is rarely a feature of pituitary adenoma, it is often impossible in the absence of a known history of malignancy to distinguish a metastatic tumor to the sella from a pituitary adenoma. Transsphenoidal sellar exploration and decompression provide the tissue diagnosis and often effect symptomatic improvement and are, therefore, the treatment of choice in appropriate patients. Adjuvant radiation therapy is usually required postoperatively. Depending on the responsiveness of the primary tumor and the clinical status of the patient, chemotherapy may also be considered.

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