Abstract
Lymphoma involving the pituitary gland is very rare and usually results from metastatic spread of systemic lymphoma. We present a case of primary central nervous system (CNS) large B cell lymphoma that manifested as pituitary apoplexy. A 45-year-old woman presented with headache, and then rapidly developed a third nerve palsy and bitemporal hemianopsia. Imaging suggested a pituitary macroadenoma, with spontaneous necrosis, extending into the suprasellar region, compressing the optic chiasm and invading the right cavernous sinus. The patient underwent transsphenoidal resection which revealed a vascular, firm tumor. An aggressive decompression of the optic chiasm was performed with complete resolution of both visual fields and third nerve palsy. Final pathology showed B cell lymphoma. Systemic work-up including bone marrow aspiration and CSF studies showed no other foci of lymphoma, and the patient was HIV-negative. Chemotherapy with methotrexate, vincristine, procarbazine, and dexamethasone was administered for primary CNS lymphoma. This is an uncommon diagnosis of which the clinician should be aware in order to tailor surgical intervention and provide early institution of proper therapy.
References
Da Silva AN, Lopes MB, Schiff D (2006) Rare pathological variants and presentations of primary central nervous system lymphomas. Neurosurg Focus 21(5):E7
Giustina A, Gola M, Doga M, Rosei EA (2001) Clinical review 136: primary lymphoma of the pituitary: an emerging clinical entity. J Clin Endocrinol Metab 86:4567–4575
Capra M, Wherrett D, Weitzman S, Dirks P, Hawkins C, Bouffet E (2004) Pituitary stalk thickening and primary central nervous system lymphoma. J Neurooncol 67:227–231
Landman RE, Wardlaw SL, McConnell RJ, Khandji AG, Bruce JN, Freda PU (2001) Pituitary lymphoma presenting as fever of unknown origin. J Clin Endocrinol Metab 86:1470–1476
Mathiasen RA, Jarrahy R, Cha ST, Kovacs K, Herman VS, Ginsberg E, Shahinian HK (2000) Pituitary lymphoma: a case report and literature review. Pituitary 2:283–287
Freda P, Post KD (1999) Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am 28:81–111
Fine HA, Mayer R (1993) Primary central nervous system lymphoma. Ann Intern Med 119:1093–1104
Eby N, Grufferman S, Flannelly C, Schold S, Vogel F, Burger P (1988) Increasing incidence of primary brain lymphoma in the US. Cancer 62:2461–2465
Ogilvie CM, Payne S, Evanson J, Lister TA, Grossman A (2005) Lymphoma metastasizing to the pituitary: an unusual presentation of a treatable disease. Pituitary 8:139–146
Semple PL, De Villiers JC, Bowen RM, Lopes MB, Laws ER Jr (2006) Pituitary apoplexy: do histological features influence the clinical presentation and outcome? J Neurosurg 104:931–937
Soni A, De Silva SR, Allen K, Byrne JV, Cudlip S, Wass JA (2007) A case of macroprolactinoma encasing an internal carotid artery aneurysm, presenting as pituitary apoplexy. Pituitary Sept 27 (Epub ahead of print)
Au WY, Kwong YL, Shek TW, Leung G, Ooi C (2000) Diffuse large-cell B-cell lymphoma in a pituitary adenoma: an unusual cause of pituitary apoplexy. Am J Hematol 63:231–232
Huang YY, Lin SF, Dunn P, Wai YY, Hsueh C, Tsai JS (2005) Primary pituitary lymphoma presenting as hypophysitis. Endocr J 52:543–549
Liu JK, Sayama C, Chin SS, Couldwell WT (2007) Extranodal NK/T-cell lymphoma presenting as a pituitary mass. Case report and review of the literature. J Neurosurg 107:660–665
Huang BY, Castillo M (2005) Nonadenomatous tumors of the pituitary and sella turcica. Top Magn Reson Imaging 16:289–299
Kaufmann TJ, Lopes MB, Laws ER Jr, Lipper MH (2002) Primary sellar lymphoma: radiologic and pathologic findings in two patients. AJNR Am J Neuroradiol 23:364–367
Elder JB, Chen TC (2006) Surgical interventions for primary central nervous system lymphoma. Neurosurg Focus 21(5):E13
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Quintero Wolfe, S., Hood, B., Barker, J. et al. Primary central nervous system lymphoma mimicking pituitary apoplexy: case report. Pituitary 12, 76–79 (2009). https://doi.org/10.1007/s11102-008-0084-8
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DOI: https://doi.org/10.1007/s11102-008-0084-8