Multimodal management of giant prolactinoma with extensive amyloid spherule deposition: a case report with review of the literature.
Aysel Unver Ozkahraman, Merve Korkmaz Yilmaz, Huseyin Karatay et al.
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Case in brief
A 49-year-old man presented with headache and visual disturbances due to a giant prolactinoma, measuring 63 × 84 × 46 mm, with significant cavernous sinus invasion and marked hyperprolactinemia (30,969 ng/mL). Histopathology revealed a sparsely granulated lactotroph tumor with extensive amyloid spherules. After surgical debulking and initial cabergoline treatment, radiotherapy was initiated due to dopamine resistance. This was followed by concurrent cabergoline and temozolomide therapy, resulting in a significant reduction in prolactin levels and tumor volume.
What made this case unusual
The presence of extensive amyloid spherule deposition in the prolactinoma, which is associated with dopamine agonist resistance and aggressive tumor behavior, is a notable feature of this case.
Diagnostic / clinical pearl
Clinicians should consider the potential for amyloid deposition in prolactinomas, as it may contribute to treatment resistance and necessitate multimodal management strategies.
Why it matters
This case highlights the possibility that radiotherapy may restore dopamine agonist sensitivity in amyloid-containing prolactinomas, allowing for effective concurrent treatment with temozolomide.