Case report suggests complete removal of ectopic pituitary adenomas is effective

The authors report the first documented case of an ectopic pituitary adenoma in the spheno-orbital region. The patient, a 66-year-old man, presented with unilateral proptosis and an ipsilateral abduction deficit.

Complete excision of the tumor eliminated proptosis and restored full ocular ductions. There were no complications. Immunohistochemical studies lead to a diagnosis of a hormonally inactive ectopic pituitary adenoma.

The authors theorize that the tumor may have originated from Rathke pouch remnant cells that migrated into the lateral wall of the sphenoid sinus and underwent a neoplastic proliferation in this location. With bone eroded, the lesion probably broke through the medial margin of the superior orbital fissure to occupy the medial part of the fissure. They say it probably grew in two directions: posterolaterally toward the temporal polar epidural space and anterolaterally to destroy the thin edge of the greater sphenoid wing and invade the orbit.

The authors conclude that early diagnosis and treatment of patients with ectopic pituitary adenomas may lead to improved outcomes. Their limited experience indicates that complete surgical removal of this spheno-orbital lesion is safe and effective. They also recommend close follow-up of patients with these lesions.