gms | German Medical Science

Objective: The sellar region is an unusual site for metastatic spread, but as patients with metastatic malignancy are living longer, it may become more prevalent in an interdisciplinary center. Compression of important anatomy adjacent to the sella may produce disabling symptoms and endocrine derangement, leading to significant morbidity.

Methods: To analyse the incidence of sellar metastasis, the authors reviewed their cases with sellar pathologies treated via an endonasal approach between January 2011 and October 2020. After identifying cases, further investigation was performed to evaluate patient demographic, symptoms at presentation, radiological and histological findings, management, and outcome.

Results: Seven of 332 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%). A biopsy was intended in two of these cases and a subtotal resection was intended in one case. In 4 of 7 cases (57%) the diagnosis was confirmed unanticipated in the histopathological final examination. Thereby, a subtotal resection was achieved in 3 cases and a near total resection in one case. 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.

Conclusion: The sellar region should not be overlooked as a site of metastasis and sellar symptoms may be the first presentation of neoplastic disease. Any biochemical or clinical sign of pituitary pathology in a patient with known cancer should raise suspicion for sellar metastasis. Moreover, the development of hormonal dysfunction or ophthalmoplegia is suggestive of metastatic disease even in patients with no known primary. Further evaluation and metaanalyis of the cases reported in the literature are required to identify the incidence and treatment of these rare sellar metastasis.