In an early meta analysis

In an early meta-analysis, diagnosing cancer of the pancreas by ERCP with the “double duct” sign had a sensitivity of 92% and specificity of 96%. In the present case, mild proximal CBD dilatation with an abrupt distal CBD stricture was detected by ERCP. The most common malignant cause of obstructive jaundice in middle-aged adults in North America is cancers of the pancreatobiliary system. Thus, EUS was performed to search for the possible organic cause of abrupt distal CBD disruption. EUS provides better image resolution compared with transabdominal ultrasonography because of the small distance between the echoendoscope and the pancreas through the gastric or duodenal wall. It also helps in obtaining tissue samples from suspicious lesions via EUS guided fine needle aspiration (EUS-FNA). In one meta-analysis, the sensitivity of EUS-FNA for pancreatic cancer was 92% and the specificity was 96%. In a previous imaging study, for diagnosis of pancreatic cancer less than 10 mm in size and pancreatic duct dilatation, the tumor detection rate was higher on EUS than on CT or other modalities, and EUS-guided fine needle aspiration was helpful in confirming the histologic diagnosis. MRI also provides high sensitivity and specificity for detection of pancreatic cancer. It has become widely used in the diagnosis of pancreatic pathologies because of its very high soft-tissue bmn 673 resolution, with an accuracy in the detection and staging of adenocarcinoma of 90–100%. MR cholangiopancreatography also provides images of pancreatic ductal system abnormalities. Furthermore, diffusion-weighted imaging (DWI) may provide further information about a wide variety of solid and cystic lesions of the pancreas and enable detection of solid pancreatic tumors with a high cellularity or fibrosis.
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Introduction Pituitary metastasis is an unusual event of cancer progression. Approximately 30% of pituitary metastasis cases originate from primary breast cancer, and the prognosis of breast cancer with pituitary metastasis is poor. According to earlier studies, most patients have clinical and/or radiologic evidence of widespread disease at the time they are diagnosed with pituitary metastasis.
Case report During follow-up, the patient complained of gradually blurred vision several months prior to admission, and bitemporal hemianopsia was noted after her physical examination. Laboratory investigation findings were consistent with the diagnosis of anterior hypopituitarism, as noted in Table 1. The patient\'s follicle stimulation and luteinizing hormone level was decreased. Magnetic resonance imaging (MRI) of the patient\'s brain showed a lobulated mass measuring 2.18*4.50 cm lesion involving the pituitary fossa with suprasellar extension, and compression of the optic chiasma (Fig. 1). There was inferior extension, causing destruction to the sella floor and to the sphenoid sinus. Thereafter, we had a neurosurgeon perform a surgical tumor removal via trans-sphenoidal route. Pathologic reports indicated mucinous carcinoma of breast metastatic to the pituitary gland, ER (8), PR (7), Her2 (0) (Figs. 2–3). Staging evaluation with PET scan revealed solitary pituitary metastasis, and brain radiation therapy was applied following surgery. During the months of follow-up, no recurrent sellar mass was observed. Patient was subsequently placed on endocrine therapy with femara and survived without relapse for over two years.
Discussion Pituitary metastasis is an unusual event of cancer progression, representing only 1% of pituitary lesions. More typically, breast and lung cancer are the most common primary neoplasm metastasizing to the pituitary in women and men, respectively. Pituitary metastases more commonly affect the posterior lobe and the infundibulum than the anterior lobe. The predilection for posterior metastases may stem from the posterior lobe\'s richer systemic blood supply via the hypophyseal artery, whereas the anterior lobe is mainly supplied by the hypophyseal portal system. The most common symptom of pituitary metastasis seems to be diabetes insipidus, reflecting a predominance of metastasis to the posterior lobe. Visual impairment resulting from optic chiasm compression seems to be the second most common presentation. However, in a series of 52 patients with pituitary metastasis, Heshmati et al found that visual impairment was more common than diabetes insipidus. In our case, the patient\'s initial presentation was of visual field defect with bitemporal hemianopsia. There was no polydipsia, and polyuria presented as the manifestation of diabetes insipidus.