Faculty Bibliography

OBJECTIVE:Pituitary carcinoma is a rare tumor, defined as a tumor of adenohypophyseal cells with systemic or craniospinal metastasis. We present a case of a growth hormone (GH)-secreting pituitary carcinoma with a review of literature to better characterize this disease. DESIGN:Case report and literature review of 25 cases of GH-secreting pituitary carcinomas RESULTS: The age of diagnosis of GH-secreting carcinomas ranged 24-69 years old with a mean age of 44.4 with 52% of cases present in females. Mean latency period between diagnosis of acromegaly and transition to pituitary carcinoma was 11.4 years with mean survival being 3.4 years. CONCLUSION:Growth hormone (GH)-secreting pituitary carcinomas are rare and hard to distinguish from aggressive pituitary adenomas. From review of literature, treatment options include debulking surgery, radiotherapy, or chemotherapy with dismal outcomes. There are no diagnostic markers or features which can predict metastatic progression of these tumors. Future studies with genomic landscapes and relevant tumor markers are needed to identify pituitary tumors most likely to metastasize.

Cardiac tumours are relatively uncommon, particularly in children. Myofibroma is an extremely rare variety of cardiac tumour, which nearly always arises in the context of infantile myofibromatosis. Herein, we present a case of a solitary cardiac myofibroma causing right ventricular outflow tract obstruction in a 2-month-old male infant.

PURPOSE/OBJECTIVE:A benign MRI-targeted prostate biopsy (MRF-TB) in the setting of a PI-RADS 4/5 abnormality presents a clinical dilemma for future management. We evaluated benign histologic features on MRF-TB to determine if they predict the likelihood of missed cancer on subsequent biopsy. MATERIALS AND METHODS/METHODS:Between 6/2012 and 9/2016, 1595 men were enrolled in a prospective study of MRI-targeted and systematic biopsy outcomes. We re-reviewed pathology from benign MRF-TB of PI-RADS 4/5 abnormalities and divided into 5 groups for comparison to outcomes of clinical follow-up: inflammation (38%), stroma/glandular hyperplasia (9%), normal prostate tissue (28%), ASAP/HGPIN (9%), and cancer in adjacent systematic cores (16%). RESULTS:88/497 (18%) men with PI-RADS 4/5 abnormality prior to initial biopsy had no cancer on MRF-TB. In follow-up, 45 men underwent repeat MRI: 12 (27%) had persistent PI-RADS 4/5 abnormalities, 17 (38%) had PI-RADS 2/3, 16 (35%) had PI-RADS 1. On repeat MRF-TB, cancer was found in 62.5% of men with PI-RADS 4/5 and 23% of men with PI-RADS 2/3. Histologic groups on initial MRF-TB were not predictive of the likelihood of PI-RADS downgrade on repeat MRI or cancer detection on repeat biopsy. CONCLUSIONS:Among men with no cancer on MRF-TB performed for PI-RADS abnormality, downgrade of PI-RADS score is noted in 73% on repeat MRI. Persistence of PI-RADS 4/5 predicts a higher risk of missed cancer, warranting prompt re-biopsy. While histologic findings such as inflammation may underlie some PI-RADS 4/5 abnormalities, initial histology is a poor predictor of cancer likelihood on repeat biopsy.