{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T20:08:37Z","timestamp":1790366917083,"version":"4.1.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T00:00:00Z","timestamp":1640044800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>Nowadays, neither imaging nor pathology evaluation can accurately predict the aggressiveness or treatment resistance of pituitary tumors at diagnosis. However, histological examination can provide useful information that might alert clinicians about the nature of pituitary tumors. Here, we describe our experience with a silent corticothoph tumor with unusual pathology, aggressive local invasion and metastatic dissemination during follow-up. We present a 61-year-old man with third cranial nerve palsy at presentation due to invasive pituitary tumor. Subtotal surgical approach was performed with a diagnosis of silent corticotroph tumor but with unusual histological features (nuclear atypia, frequent multinucleation and mitotic figures, and Ki-67 labeling index up to 70%). After a rapid regrowth, a second surgical intervention achieved successful debulking. Temozolomide treatment followed by stereotactic fractionated radiotherapy associated with temozolomide successfully managed the primary tumor. However, sacral metastasis showed up 6 months after radiotherapy treatment. Due to aggressive distant behavior, a carboplatine-etoposide scheme was decided but the patient died of urinary sepsis 31 months after the first symptoms. Our case report shows how the presentation of a pituitary tumor with aggressive features should raise a suspicion of malignancy and the need of follow up by multidisciplinary team with experience in its management. Metastases may occur even if the primary tumor is well controlled.<\/jats:p>","DOI":"10.3389\/fendo.2021.784889","type":"journal-article","created":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T04:56:14Z","timestamp":1640062574000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["A Silent Corticotroph Pituitary Carcinoma: Lessons From an Exceptional Case Report"],"prefix":"10.3389","volume":"12","author":[{"given":"Pablo","family":"Rem\u00f3n-Ruiz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Venegas-Moreno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Dios-Fuentes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Manuel Canelo","family":"Moreno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Fernandez Pe\u00f1a","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam Alonso","family":"Garcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel Angel","family":"Jap\u00f3n-Rodriguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florinda","family":"Rold\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Fajardo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Kaen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenio Cardenas","family":"Ruiz-Valdepe\u00f1as","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Cano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Soto-Moreno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-2231","article-title":"Diagnosis and Management of Pituitary Carcinomas","volume":"90","author":"Kaltsas","year":"2005","journal-title":"J Clin Endocrinol Metab"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-017-1769-8","article-title":"The 2017 World Health Organization Classification of Tumors of the Pituitary Gland: A Summary","volume":"134","author":"Lopes","year":"2017","journal-title":"Acta Neuropathol (Berl)"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-021-00550-w","article-title":"Aggressive Pituitary Tumours and Pituitary Carcinomas","volume":"17","author":"Raverot","year":"2021","journal-title":"Nat Rev Endocrinol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-014-0525-y","article-title":"Invasive Adenoma and Pituitary Carcinoma: A SEER Database Analysis","volume":"37","author":"Hansen TM BS Lim","year":"2014","journal-title":"Neurosurg Rev"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-013-1084-y","article-title":"A New Prognostic Clinicopathological Classification of Pituitary Adenomas: A Multicentric Case-Control Study of 410 Patients With 8 Years Post-Operative Follow-Up","volume":"126","author":"Trouillas","year":"2013","journal-title":"Acta Neuropathol (Berl)"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-020-09562-9","article-title":"Are Aggressive Pituitary Tumors and Carcinomas Two Sides of the Same Coin? 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