Metastasen der Sella: eine seltene intraoperative Beobachtung nach Vortäuschung eines Hypophysenadenoms im präoperativen MRT

The sellar region is an unusual site for metastatic spread, but as patients with metastatic malignancy are living longer, it may become more prevalent. Compression of important anatomy adjacent to the sella may produce disabling symptoms and endocrine derangement, leading to significant morbidity. Furthermore, the preoperative imaging is probably often mimicing an adenoma in these cases.

To analyse the incidence of sellar metastasis, the authors reviewed their cases with sellar pathologies treated via an endonasal approach between January 2011 and Dezember 2023. Further investigation was performed to evaluate patient demographic, radiological and histological findings and outcome.

Eight of 374 patients (2.1%) treated during this time period revealed in the final histopathology a metastasis. Thereby, malignant tumor history was known in one patient (14%). The preoperative MR and CT imaging suspected a malignant pathology or metastasis in two cases (28%). in 72% oif all cases the MR and CT imaging revealed a piuitary adenoma most likely preoperatively. The average age of the cases was 63.4 years, with histopathological diagnosis of two metastasis of lung cancer, one mestastasis of gastric cancer, one metastasis of kidney, one case of prostatic cancer, one lymphoma and one plasmocytoma. Adenohypophyseal dysfunction (3/7; 42%), abducens palsy (2/7; 28%) and visual field defects (2/7; 28%) were the most common findings at presentation. The mean follow up was 2.4 years. 5 of 7 patients (71%) died during this time period.

The sellar region should not be overlooked as a site of metastasis. Any biochemical or clinical sign of pituitary pathology in a patient with known cancer should raise suspicion for sellar metastasis even if the preoperative imaging argues for a pituitary adenoma most likely. Moreover, the fast development of hormonal dysfunction or ophthalmoplegia is suggestive of metastatic disease even in patients with no known primary.