| Autor: |
Wallace J; Department of Radiology, Eastern Virginia Medical School, 600 Gresham Dr, Norfolk, VA 23507, USA., Krupa M; Department of Radiology, Eastern Virginia Medical School, 600 Gresham Dr, Norfolk, VA 23507, USA., Brennan J; Department of Radiology, Eastern Virginia Medical School, 600 Gresham Dr, Norfolk, VA 23507, USA., Mihlon F; Department of Radiology, Eastern Virginia Medical School, 600 Gresham Dr, Norfolk, VA 23507, USA. |
| Abstrakt: |
Ipilimumab is an immunotherapeutic agent used in the treatment of metastatic melanoma, and is known to cause hypophysitis in some patients. Magnetic resonance imaging of ipilimumab-induced hypophysitis typically shows diffuse enlargement of the pituitary gland with variable enhancement or enlargement of the infundibulum. This often produces a diagnostic dilemma as melanoma not uncommonly metastasizes to the pituitary gland due to the rich vascular plexus of the hypophyseal portal system, and has a similar imaging appearance to autoimmune hypophysitis. We present a case of a 49-year-old man with a Clark level 4 melanoma of the left calf with inguinal nodal metastases that was treated with resection and 2 cycles of ipilimumab, and subsequently developed a "cystic" pituitary mass. To our knowledge, all of the described cases of ipilimumab-induced hypophysitis to date have shown solid enhancement on imaging. Because metastatic melanoma to the pituitary gland often has internal hemorrhage that produces a "cystic" appearance, and ipilimumab-induced hypophysitis is typically a solidly enhancing abnormality, this presented a significant diagnostic and therapeutic dilemma. Our patient's symptoms, although significant, did not necessitate immediate surgical intervention, and a conservative approach of withholding the ipilimumab and administering therapeutic corticosteroids was pursued. The patient's symptoms abated and follow-up magnetic resonance imaging 1 month later showed near complete resolution of the pituitary abnormalities. As such, this is a unique case of ipilimumab-induced hypophysitis presenting as a "cystic" pituitary mass. |
