Long-term Survival With Non-functioning Pituitary Carcinoma

A 35-year-old woman presented with a non-functioning pituitary adenoma manifesting as amenorrhea and impaired visual acuity in 1984. The tumor was grossly totally resected through a right frontotemporal craniotomy. The patient underwent surgery for three recurrences in the next 5 years. She was treated with gamma knife surgery for the residual tumor in 1994. Follow-up magnetic resonance (MR) imaging revealed a tumor in the right frontal base in 1999, and the left middle fossa in 2002. Total removal of these tumors was performed. Follow-up MR imaging showed regrowth of the primary pituitary tumor in 2003, which was partially excised. Histological examination of the specimens from the last three surgeries revealed typical pituitary adenoma without malignant transformation. Pituitary carcinomas have a poor prognosis. However, the present patient survived for 22 years from onset and 6 years from the first dural metastasis. Distant lesions should be removed for histological evaluation to assist the subsequent management.