| Identifier |
walsh_2022_s2_c5 |
| Title |
Double Crossed |
| Creator |
Jeffrey Gluckstein; Melanie Lang-Orsini; Joseph Rizzo |
| Affiliation |
(JG) (JR) Massachusetts Eye and Ear Infirmary, Somerville, Massachusetts; (ML) Massachusetts General Hospital, Boston, Massachusetts |
| Subject |
optic chiasm, malignant melanoma, pituitary surgery (transphenoidal adenomectomy) |
| History |
A 58-year-old man presented for the development of new stabbing headaches and blurry vision in the right eye. Over; several months, his symptoms progressed to 'smudging' of his temporal field in the right eye, difficulty separating similar; colors, and binocular horizontal diplopia worse at near. Medical history was notable for a melanoma resected from the; right arm with negative margins 8 years prior to presentation with normal screening examinations thereafter. His initial; ophthalmic exam showed visual acuities of 20/125 eccentrically OD and 20/40 OS, a trace right rAPD, ⅛ color plates OD and; ⅜ color plates OS. Fundus exam revealed macular edema OD. Automated visual fields showed a complete right temporal; hemifield defect OD with nonspecific defects OS. OCT showed subretinal fluid and choroidal neovascularization OD. An MRI; showed a large mass extending from the sella and superiorly displacing the chiasm, inferior frontal lobes, and cavernous; sinus with osseous erosion of the adjacent bony structures and multifocal hemorrhage within the lesion. He received urgent; transsphenoidal pituitary resection to relieve the compression of his right optic nerve, though the left portion of the lesion; was left untouched due to encasement of the carotid. Pathology showed a gonadotroph adenoma with a markedly elevated; proliferation index of 22.8% and scattered areas of necrosis. He received intravitreal bevacizumab in consultation with the; retina service for his choroidal neovascular membrane. Repeat neuro-ophthalmic examination one month after surgery; showed visual acuities of 20/125 OD and 20/20 OS with a right rAPD, 8/8 color plates OU, and dramatically improved visual; fields. Follow up MRI two months after surgery showed a significant interval increase in the size of his pituitary lesion with; extension into the resection cavity and new multifocal contrast enhancing brain lesions. Additional examination and; imaging was performed. |
| Disease/Diagnosis |
Melanoma metastasis to pituitary gonadotroph adenoma |
| Date |
2022-02 |
| References |
Lamorie-Foote, K., Rangwala, S. D., Kammen, A., Gnass, E., Kramer, D. R., Rutkowski, M., ... & Zada, G. Melanoma metastasis; to a nonfunctioning pituitary macroadenoma: illustrative case. Journal of Neurosurgery: Case Lessons, 1(23). (2021).; Castle-Kirszbaum, M., Phung, T. B., Luen, S. J., Rimmer, J., Chandra, R. V., & Goldschlager, T. A pituitary metastasis, an; adenoma and potential hypophysitis: A case report of tumour to tumour metastasis in the pituitary. Journal of Clinical; Neuroscience, 81, 161-166. (2020).; Aaberg Jr, T. M., Kay, M., & Sternau, L. Metastatic tumors to the pituitary. American journal of ophthalmology, 119(6), 779-; 785. (1995). |
| Language |
eng |
| Format |
application/pdf |
| Type |
Text |
| Source |
54th Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2022 |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Walsh Session Annual Meeting Archives: https://novel.utah.edu/Walsh/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2022. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6bedjp2 |
| Setname |
ehsl_novel_fbw |
| ID |
2100238 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6bedjp2 |
