A Case of Corticotroph Carcinoma that Caused Multiple Cranial Nerve Palsies, Destructive Petrosal Bone Invasion, and Liver Metastasis

摘要: A 52-year-old woman experienced sudden onset of double vision due to a right abducens nerve palsy and was diagnosed as having pituitary macroadenoma that invaded into the cavernous sinus. Otherwise, she asymptomatic despite marked elevation ACTH (293 pg/ml) cortisol (24.6 μg/dl) levels. The patient underwent transsphenoidal surgery followed by γ-knife radiosurgery (GKR), which healed diplopia ameliorated hypercortisolemia. excised tumor diffusely stained for with high (15%) Ki-67 labeling index. Early recurrence occurred twice thereafter, producing lower cranial palsies petrosal bone destruction at 8 months an ipsilateral oculomotor 12 months after GKR; all resolved completely second third GKRs. Hypercortisolemia worsened rapidly soon GKR, developed weight gain, hypokalemia, hypertension. Multiple liver lesions were incidentally detected computer tomography identified metastatic on immunohistochemistry. An ACTH-producing adenoma should be carefully early and/or spread when is invasive proliferation marker level. unique aggressive behavior potential malignant transformation this case are discussed.