Henry Ford Hospital Medical Journal


Criteria for the diagnosis of pituitary carcinoma are subject to controversy. Some authors do not accept the demonstration of cellular anaplasia alone as sufficient to establish the diagnosis but require evidence of metastatic disease in order to label a pituitary tumor as malignant. However, pituitary tumors can metastasize even in the absence of anaplasia. The present case of Cushing's disease and pituitary carcinoma had no clinical evidence of metastases when first reported. Partial surgical removal of the tumor followed by irradiation resulted in clinical remission of the Cushing's syndrome, but two years later progressive uncontrollable recurrence of the disease ended in death. At autopsy, evidence of metastatic pituitary carcinoma was found throughout the central nervous system. This case illustrates that the diagnosis of pituitary carcinoma can be made correctly even in the absence of demonstrable metastases on the basis of cytological and clinical criteria.