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Sreedhara P, Czerwinski V, Alexander E, Choudhary C. T-cell Lymphoblastic Lymphoma Presenting as a Pituitary Mass. JCEM CASE REPORTS 2023; 1:luad097. [PMID: 37908217 PMCID: PMC10580472 DOI: 10.1210/jcemcr/luad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Indexed: 11/02/2023]
Abstract
Primary pituitary T-lymphoblastic lymphoma is a rare clinical entity. A 45-year-old woman presented with headache, left-eye blurry vision, diplopia, ophthalmoplegia, and ptosis. Magnetic resonance imaging of the brain showed a sellar mass most likely consistent with a pituitary macroadenoma. Laboratory evaluation disclosed secondary hypothyroidism, secondary adrenal insufficiency, and hyperprolactinemia. The mass was removed by transsphenoidal resection, and subsequent immunophenotyping revealed T-cell lymphoblastic lymphoma. Secondary workup confirmed lymphomatous confinement to the central nervous system. Following resection, the patient's headaches improved, but she experienced persistent visual deficits and palsies of cranial nerves III, IV, and VI. The chemotherapy regimen consisted of high-dose methotrexate, followed by alternating cycles of cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride (Adriamycin), dexamethasone (cyclophosphamide, mesna, vincristine sulfate, doxorubicin hydrochloride, dexamethasone), and methotrexate/cytarabine. Since receiving chemotherapy, there has been an improvement in numbness, ptosis, left orbital pressure, and headaches. This case represents only the eighth example of T-cell primary pituitary lymphoma, and the youngest patient to receive the diagnosis.
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Affiliation(s)
- Padmini Sreedhara
- Internal Medicine, University of Kansas School of Medicine, Kansas City, KS 66204, USA
| | - Vincent Czerwinski
- Internal Medicine, University of Kansas School of Medicine, Kansas City, KS 66204, USA
| | - Ethan Alexander
- Division of Endocrinology, Metabolism, Diabetes, Clinical Pharmacology, University of Kansas School of Medicine, Kansas City, KS 66204, USA
| | - Chitra Choudhary
- Division of Endocrinology, Metabolism, Diabetes, Clinical Pharmacology, University of Kansas School of Medicine, Kansas City, KS 66204, USA
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2
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Ren S, Lu Q, Xiao Y, Zhang Y, Zhang L, Li B, Li M. Coexistence of Pituitary Adenoma and Primary Pituitary Lymphoma: A Case Report and Review of the Literature. Front Surg 2022; 9:842830. [PMID: 35372490 PMCID: PMC8966133 DOI: 10.3389/fsurg.2022.842830] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
In the pituitary sella, the coexistence of pituitary adenoma and primary pituitary lymphoma is exceedingly rare. Thus far, only six cases have been reported. Here, we present the seventh case of coexisting pituitary adenoma and primary pituitary lymphoma, which was difficult to differentiate from other sellar tumors. To our knowledge, this is the first case of the prolactin subtype of the pituitary adenoma in literature. We have also systematically reviewed the literature and summarized the characteristics of coexisting pituitary adenoma and lymphoma. We believe this report provides a new clinical reference for the diagnosis and treatment of collision tumors of pituitary adenoma and lymphoma.
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Affiliation(s)
- Shangjun Ren
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Qingyang Lu
- Department of Pathology, Liaocheng People's Hospital, Liaocheng, China
| | - Yilei Xiao
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Yiming Zhang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Lianqun Zhang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Bin Li
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Mengyou Li
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
- *Correspondence: Mengyou Li
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3
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Caputo M, Prencipe N, Bisceglia A, Bona C, Maccario M, Aimaretti G, Grottoli S, Gasco V. Primary Pituitary Lymphoma As Rare Cause Of A Pituitary Mass And Hypopituitarism In Adulthood. Endocr Pract 2021; 26:1337-1350. [PMID: 33471665 DOI: 10.4158/ep-2020-0286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Differential diagnosis of nonadenomatous sellar masses causing hypopituitarism is still a challenge. Among these masses, growing evidence has demonstrated that primary pituitary lymphoma is a specific and emerging entity. The aim of our study was to describe our experience with a case of primary pituitary lymphoma and to perform a review of the available literature. METHODS We searched relevant databases up to March 2020, identifying 36 suitable articles basing on inclusion criteria (primary pituitary lymphoma in adult immunocompetent subjects). Overall, 43 cases were included in the review, adding a new case diagnosed and treated in our hospital. Epidemiologic data, clinical presentation, hormonal status, radiologic findings, pathology, treatment, and outcome were extracted. RESULTS Mean age at diagnosis was 58.9 years, without gender difference. Symptoms related to mass were common (52.3%), in particular cranial nerve palsy (70.5%), headache (56.8%), and alteration in visual field (40.9%). Impaired hormonal status was detected in 89.7% of patients; of them, 58.9% presented with anterior pituitary failure (partial or total), while 25.6% presented with panhypopituitarism. Overall, diabetes insipidus was present in 30.8% and hyperprolactinemia in 41.0% of patients. The majority of patients presented a radiologically invasive mass in the suprasellar region and cavernous sinus (65.9% and 40.9%, respectively) and histologic diagnosis of diffuse B-cell lymphoma (54.5%). CONCLUSION The differential diagnosis of sellar and parasellar masses causing hypopituitarism should include primary pituitary lymphoma, even in absence of systemic symptoms or posterior pituitary dysfunction. The disease has a heterogeneous pattern, so a collaboration between endocrinologists, neuroradiologists, neurosurgeons, and hematologists is desirable.
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Affiliation(s)
- Marina Caputo
- Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
| | - Nunzia Prencipe
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Torino, Italy
| | - Alessandro Bisceglia
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Torino, Italy
| | - Chiara Bona
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Torino, Italy
| | - Mauro Maccario
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Torino, Italy
| | - Gianluca Aimaretti
- Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Silvia Grottoli
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Torino, Italy
| | - Valentina Gasco
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Torino, Italy
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4
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Fridlyand DM, Keller FG, Sabnis HS, Patterson BC, Gadde JA, Peragallo JH, Biousse V, Wechsler DS. Very late recurrence of B-cell acute lymphoblastic leukemia masquerading as a pituitary tumor. Pediatr Hematol Oncol 2020; 37:438-444. [PMID: 32299275 DOI: 10.1080/08880018.2020.1751754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Involvement of the pituitary gland by leukemic infiltration is exceedingly rare. Here, we describe a very late recurrence of B-cell acute lymphoblastic leukemia masquerading as a pituitary tumor and review the literature for previously reported cases. Our female patient presented 13 years after completion of therapy for B-ALL with headache, amenorrhea, galactorrhea and a pituitary mass. Subsequent studies revealed recurrence of her leukemia, and the pituitary lesion resolved after induction chemotherapy. Our case highlights the importance of considering leukemic infiltrate in the differential diagnosis of pituitary mass, particularly in a patient with a history of hematologic malignancy, sparing unnecessary surgical intervention and informing endocrine evaluation. In addition, the case also highlights difficulties with characterizing this recurrence as a very late relapse or clonal evolution of the original leukemia.
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Affiliation(s)
- Diana M Fridlyand
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Frank G Keller
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Himalee S Sabnis
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Briana C Patterson
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Judith A Gadde
- Department of Radiology and Imaging Services, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jason H Peragallo
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel S Wechsler
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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5
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Shin DW, Kim JH, Kim YH, Cho YH, Hong SH. Primary central nervous system lymphoma involving the hypothalamic-pituitary axis: a case series and pooled analysis. J Neurooncol 2020; 147:339-349. [PMID: 32221784 DOI: 10.1007/s11060-020-03422-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/31/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) involving the hypothalamic-pituitary axis (H-P axis) is a rare intracranial neoplasm. We aimed to determine the unique characteristics and treatment outcomes of patients with PCNSL at the H-P axis and review the literature. METHODS We retrospectively reviewed the electronic medical records of patients with PCNSL in our institute from 2000 to 2017. We analyzed patient characteristics, clinicopathologic features, imaging results, and treatment outcomes. Furthermore, we searched the PubMed database and gathered more cases from published studies to analyze patient treatment outcomes. RESULTS A total of 488 patients were diagnosed with central nervous system lymphoma at our institute. Seven (1.4%) patients had H-P axis involvement, five had diffuse large B-cell lymphoma, and two had mucosa-associated lymphoid tissue lymphoma. All patients had anterior pituitary lobe dysfunction, and two had posterior lobe dysfunction. The median progression-free survival (PFS) for seven patients was 29.0 (range: 0.9-48.1) months, and the 3-year survival rate was 42.9%. Pooled analysis included 45 patients. The median PFS for these patients was 7.0 months (0.9-52.0), and the 2-year survival rate was 20%. Univariate and multivariate analyses revealed that the patients with visual field defects had better prognosis (p = 0.0153 and 0.043, respectively). CONCLUSION PCNSL at the H-P axis is associated with a higher rate of pituitary dysfunction than other parasellar pathologies. PCNSL at the H-P axis has a worse treatment outcome than PCNSL at other sites. However, visual field defect is related to a favorable prognosis in these patients.
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Affiliation(s)
- Dong-Won Shin
- Department of Neurosurgery, College of Medicine, Asan Medical Center, University of Ulsan, 388-1 Pungnab-dong, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Jeong Hoon Kim
- Department of Neurosurgery, College of Medicine, Asan Medical Center, University of Ulsan, 388-1 Pungnab-dong, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Young-Hoon Kim
- Department of Neurosurgery, College of Medicine, Asan Medical Center, University of Ulsan, 388-1 Pungnab-dong, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Young Hyun Cho
- Department of Neurosurgery, College of Medicine, Asan Medical Center, University of Ulsan, 388-1 Pungnab-dong, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Seok Ho Hong
- Department of Neurosurgery, College of Medicine, Asan Medical Center, University of Ulsan, 388-1 Pungnab-dong, Songpa-gu, Seoul, 138-736, Republic of Korea
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6
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Duan L, Liu J, Zhang Y, Cui L, Zhai X, Pan B, Lu L, Pan H, Yao Y, Zhu H. Primary Pituitary Lymphoma in Immunocompetent Patients: A Report on Two Case Studies and the Review of Literature. Front Endocrinol (Lausanne) 2020; 11:562850. [PMID: 33613443 PMCID: PMC7890261 DOI: 10.3389/fendo.2020.562850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022] Open
Abstract
Primary pituitary lymphoma (PPL) represents an extremely rare entity. Here, we have reported two recently identified cases of immunocompetent PPL having diffuse large B-cell lymphoma by surgical biopsy. Both patients had hypopituitarism, with one patient developing right ptosis. In both patients, MRI and FDG-PET/CT depicted sellar mass that extended into the cavernous sinus with the right sphenoid also present in one of the patients. No systemic disease was found in these two patients. Surprisingly, we found that both patients had infiltrative lesions in sphenoid sinus mucosa pathologically, but the sphenoid bones that composed the sellar base were visually intact during the biopsy procedure. Chemotherapy was administered to both patients, where one patient achieved remission at the recent follow-up, whereas the other one did not respond to the treatment. The diagnosis of PPL is usually difficult if solely dependent on history, clinical presentation, biochemical indexes, and radiographic findings. We have also updated and reviewed the epidemiologic features, clinical presentations, pathological characteristics, potential mechanisms, therapeutic orientation, and prognostic advances of PPL. A total of 40 cases (including ours and four pediatric patients), histologically diagnosed, were analyzed in terms of clinical presentation, endocrine abnormality, radiological features, pathology, treatment, and follow-up. Hypopituitarism and headache were the most common presentation of PPL, while diabetes insipidus was reported in 13 patients (43.3%). B cell lymphoma was the most common type of pathology, followed by T-cell and NK/T cell. PPL was more invasive in nature at the suprasellar region (72.5%), cavernous sinus (52.5%), and sphenoidal sinus (27.5%) in 29, 21, and 11 patients, respectively. Pediatric patients with PPL seem to be different compared to their adult counterparts in terms of pathogenesis, clinical presentation, and radiological features. The management of PPL usually follows the treatment protocols for PCNSL but has a poor prognosis compared to the pituitary involvement of systemic lymphoma.
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Affiliation(s)
- Lian Duan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jie Liu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yan Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lijia Cui
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiao Zhai
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Boju Pan
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lin Lu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Yong Yao, ; Huijuan Zhu,
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Yong Yao, ; Huijuan Zhu,
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7
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Ban VS, Chaudhary BR, Allinson K, Santarius T, Kirollos RW. Concomitant Primary CNS Lymphoma and FSH-Pituitary Adenoma Arising Within the Sella. Entirely Coincidental? Neurosurgery 2017; 80:E170-E175. [PMID: 28362886 PMCID: PMC5808144 DOI: 10.1093/neuros/nyw003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 11/22/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND IMPORTANCE: Collision tumors are the simultaneous occurrence of more than one type of neoplasm within an anatomic space. In the pituitary sella, collision tumors are exceedingly rare, and not much is known about their etiology and prognosis. CLINICAL PRESENTATION: A 74-year-old man presented with a concomitant primary pituitary lymphoma (diffuse large B-cell non-Hodgkin's lymphoma; DLBCL) and follicle-stimulating hormone (FSH)-adenoma diagnosed histologically after clinical features of apoplexy prompted urgent surgical decompression and resection. Strong immunoreactivity for FSH by the lymphoma was evident. Full-body workup demonstrated no other source for the lymphoma. He subsequently underwent 4 cycles of chemotherapy and has been in remission for over 32 months. His ophthalmoplegia at presentation persisted with no further deficits. CONCLUSIONS: Four cases of collision tumors of primary pituitary lymphoma and adenoma have previously been reported. This case represents the first combination of an FSH-adenoma and a DLBCL in the literature. Prompt involvement of the hematology-oncology team contributed to the good outcome seen in this case. The putative role played by pituitary hormones in tumorigenesis is reviewed in this case report. The association is either a chance occurrence or due to the induction of lymphoma cell proliferation by the binding of FSH produced by the adenoma to the FSH receptors on the lymphoma cells.
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Affiliation(s)
- Vin Shen Ban
- Division of Neurosurgery, Addenbroo-ke's Hospital, Cambridge, UK
| | | | - Kieren Allinson
- Depart-ment of Histopathology, Addenbrooke's Hospital, Cambridge, UK
| | - Thomas Santarius
- Division of Neurosurgery, Addenbroo-ke's Hospital, Cambridge, UK
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8
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Gupta RK, Saran RK, Srivastava AK, Jagetia A, Garg L, Sharma MC. T cell lymphoblastic lymphoma/leukemia within an adrenocorticotropic hormone and thyroid stimulating hormone positive pituitary adenoma: A cytohistological correlation emphasizing importance of intra-operative squash smear. Neuropathology 2017; 37:358-364. [DOI: 10.1111/neup.12375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Rakesh K. Gupta
- Department of Pathology; G B Pant Institute of Postgraduate Medical Education and Research; New Delhi India
| | - Ravindra K. Saran
- Department of Pathology; G B Pant Institute of Postgraduate Medical Education and Research; New Delhi India
| | - Arvind K. Srivastava
- Department of Neurosurgery; G B Pant Institute of Postgraduate Medical Education and Research; New Delhi India
| | - Anita Jagetia
- Department of Neurosurgery; G B Pant Institute of Postgraduate Medical Education and Research; New Delhi India
| | - Lalit Garg
- Department of Radiodiagnosis; G B Pant Institute of Postgraduate Medical Education and Research; New Delhi India
| | - Mehar C. Sharma
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
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9
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Tarabay A, Cossu G, Berhouma M, Levivier M, Daniel RT, Messerer M. Primary pituitary lymphoma: an update of the literature. J Neurooncol 2016; 130:383-395. [PMID: 27581598 DOI: 10.1007/s11060-016-2249-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/20/2016] [Indexed: 11/27/2022]
Abstract
Primary intracranial lymphomas (Weller et al. in Neuro Oncol 14(12):1481-1484, 2012) are an emerging disease and an isolated localization in the pituitary gland i.e. primary pituitary lymphoma (PPL) represents a rare condition. We present an update of the most recent evidence for PPL through a systematic review of the literature. A systematic literature review was conducted using PubMed database up to October 2015. The population was defined as immunocompetent patients with a pathologically confirmed diagnosis of PPL. Patients' characteristics, clinical presentation, radiological features, pathology reports, adjuvant treatment and follow-up data were analyzed. We reported one case of PPL and included our data in this analysis. A total of 33 cases of PPL were identified, including ours. A slight not significant female prevalence was evident, with a mean age of 59 years at diagnosis. Visual troubles and headaches were the most common presenting symptoms. About 80 % of patients presented a cranial nerve (CN) deficit. The most frequently involved were the II and III CN. Anterior hypopituitarism was present in 70 % of cases and a diabetes insipidus in 36 % of cases. PPL was rarely limited to the sella and most often extended to the suprasellar and parasellar space. 70 % of cases underwent resection, 21 % a biopsy. A B-cell lymphoma was isolated in 82 % of cases, a T-cell lymphoma in 15 % and a NK/T cell lymphoma in one case. Overall mean survival rate was 14.4 months (95 % confidence interval 9.0-19.8 months) and there was no difference in terms of survival rates when patients were stratified according to the treatment they received. PPL is an emerging clinical entity. Literature data are too scarce to allow the definition of specific protocols of treatment and the management is based on the guidelines present for PCNSL. The role of surgery aiming at a complete resection of PPL should be reevaluated in wider studies including only this category of patients, to establish the real role of each therapeutic strategy.
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Affiliation(s)
- A Tarabay
- Department of Neurosurgery, University Hospital of Lausanne, Rue du Bugnon 46, 1010, Lausanne, Switzerland
| | - G Cossu
- Department of Neurosurgery, University Hospital of Lausanne, Rue du Bugnon 46, 1010, Lausanne, Switzerland
| | - M Berhouma
- Skull Base Surgery Unit, Department of Neurosurgery B, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Lyon, France
| | - M Levivier
- Department of Neurosurgery, University Hospital of Lausanne, Rue du Bugnon 46, 1010, Lausanne, Switzerland
| | - R T Daniel
- Department of Neurosurgery, University Hospital of Lausanne, Rue du Bugnon 46, 1010, Lausanne, Switzerland
| | - M Messerer
- Department of Neurosurgery, University Hospital of Lausanne, Rue du Bugnon 46, 1010, Lausanne, Switzerland.
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10
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Rainsbury P, Mitchell-Innes A, Clifton N, Khalil H. Primary lymphoma of the pituitary gland: an unusual cause of hemianopia in an immunocompetent patient. JRSM SHORT REPORTS 2012; 3:55. [PMID: 23301143 PMCID: PMC3434436 DOI: 10.1258/shorts.2012.012067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Pg Rainsbury
- Salisbury District Hospital , Salisbury , Wiltshire SP2 8BJ , UK
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11
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Morita K, Nakamura F, Kamikubo Y, Mizuno N, Miyauchi M, Yamamoto G, Nannya Y, Ichikawa M, Kurokawa M. Pituitary lymphoma developing within pituitary adenoma. Int J Hematol 2012; 95:721-4. [DOI: 10.1007/s12185-012-1075-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 04/04/2012] [Accepted: 04/05/2012] [Indexed: 11/28/2022]
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12
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Wiens AL, Hagen MC, Bonnin JM, Rizzo KA. T-cell lymphoblastic lymphoma/leukemia presenting as a pituitary mass lesion: a case report and review of the literature. Neuropathology 2012; 32:668-74. [PMID: 22432597 DOI: 10.1111/j.1440-1789.2012.01314.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We present a rare case of primary T-cell lymphoblastic lymphoma of the pituitary gland. A 58-year-old woman presented with headaches, right-sided ptosis and cranial nerve III palsy. She subsequently developed polyuria, polydipsia, and hyperglycemia and was found to have hypopituitarism. MRI revealed a large, heterogeneously enhancing intrasellar/suprasellar lesion displacing the optic chiasm and extending into the right cavernous sinus. Radiologically, these findings were thought to represent an invasive pituitary adenoma. Pterional craniotomy was performed with subtotal tumor resection. Histopathological examination revealed a T-cell lymphoblastic lymphoma/leukemia (T-LBL) admixed with pituitary corticotrophic cell hyperplasia. CT scans of the chest, abdomen and pelvis showed no evidence of systemic disease. Analysis of peripheral blood and bone marrow, including flow cytometry, demonstrated no involvement by T-LBL. Follow-up MRI of the spine revealed abnormalities in the distal thoracic spinal cord and conus medullaris, raising suspicions of leptomeningeal dissemination. Only five case reports of T-cell primary pituitary lymphoma (PPL) have been previously described, four of which were associated with hypopituitarism and/or concurrent pituitary adenoma. We present the first report of a T-cell PPL associated with adenohypophyseal hyperplasia and the third documented occurrence of a primary pituitary T-LBL.
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Affiliation(s)
- Andrea L Wiens
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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13
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Carrasco CA, Rojas-Z D, Chiorino R, González G. Primary pituitary lymphoma in immunocompetent patient: diagnostic problems and prolonged follow-up. Pituitary 2012; 15:93-6. [PMID: 20146099 DOI: 10.1007/s11102-010-0219-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Primary pituitary lymphoma in immunocompetent patients is a rare disease and has been described in less than 20 cases. Moreover, low-grade lymphomas constitute only 3% of all primary central nervous system lymphoma. The objective of this report is to report a low-grade primary pituitary lymphoma, diagnostic problems and to give more evidence about the evolution of this rare disease. A 49 y.o. woman was referred to our clinic with symptoms of hypopituitarism. A diagnostic work-up showed mild anemia, an erythrocyte sedimentation rate of 122 mm/h and a negative Elisa test for HIV. Panhypopituitarism was confirmed and the MRI showed a 20 mm sellar and suprasellar enhancing mass with a thickening of the pituitary stalk, chiasmal compression and bitemporal hemianopsia. She underwent transsphenoidal resection only 10 months later for non medical reasons. During this period she was clinically asymptomatic on hormonal replacement therapy. A new MRI showed regression of the suprasellar extension and invasion to the left cavernous sinus. A firm and infiltrative mass was found during transsphenoidal surgery, and only partial resection was performed. Biopsy showed a low-grade lymphoplasmacytic lymphoma. Staging was negative for other localizations. She was given chemotherapy and localized radiotherapy. Four years after surgery, the sellar MRI showed a 10 mm residual sellar mass with the persistence of a cavernous sinus invasion and she is considered to be in remission. The neurosurgeon and clinician should consider primary pituitary lymphoma as a potential cause of a sellar mass, especially in the presence of diabetes insipidus and an enhancing invasive mass. Neurosurgical biopsy is crucial for a correct diagnosis and prognosis could be better than classic CNS primary lymphomas.
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Affiliation(s)
- Carmen A Carrasco
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Lira 85, 5º Piso, Santiago, Chile.
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Primary pituitary lymphoma in an immunocompetent patient: a rare clinical entity. J Neurol 2011; 259:297-305. [PMID: 21932128 DOI: 10.1007/s00415-011-6179-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 02/19/2011] [Accepted: 07/09/2011] [Indexed: 02/05/2023]
Abstract
Primary pituitary lymphoma in immunocompetent patients is an exceedingly rare clinical entity. We report the case of a 41-year-old woman with initial polydipsia and polyuria. When laboratory evaluation revealed panhypopituitarism, a pituitary enhanced MRI was performed and was suggestive of a pituitary adenoma. Obstructive hydrocephalus provoked by enlarged sellar mass was also demonstrated during observation, and a shunt procedure following lesion resection was carried out. Histopathological examination and immunophenotyping verified diffuse large B-cell non-Hodgkin's lymphoma. No systemic disease was found on staging of the patient. We will also review the clinical, radiological features and outcomes of 28 cases that have been reported since 1993.
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Yasuda M, Akiyama N, Miyamoto S, Warabi M, Takahama Y, Kitamura M, Yakushiji F, Kinoshita H. Primary sellar lymphoma: intravascular large B-cell lymphoma diagnosed as a double cancer and improved with chemotherapy, and literature review of primary parasellar lymphoma. Pituitary 2010; 13:39-47. [PMID: 19707877 DOI: 10.1007/s11102-009-0196-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Lymphoma is one of the causative factors of hypothalamus-pituitary dysfunction, and intravascular large B-cell lymphoma (IVLBCL) is a subtype of primary extranodal neoplasm. A 69-year-old woman visited our hospital because of general fatigue. We diagnosed her with presumable non-functional primary pituitary adenoma and subsequent dysfunction. Eight months after, the patient revisited our hospital because of dyspnea. Though we conducted systemic investigations including chest and abdomen enhanced computer tomography, transbronchial lung biopsy, and bone marrow biopsy, the diagnosis was not confirmed. Inadvertently, a breast cancer was found, and the surgical specimen proved that the patient had double cancer-adenocarcinoma and IVLBCL. Rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone regimen was initiated, and complete remission was achieved. Notably, the sellar mass returned to normal size with improved function. We reviewed 32 patients with primary parasellar lymphoma. In affected sites, both sellar and pituitary stalk (6.7%), both hypothalamus and pituitary stalk (6.7%), only sellar (63.3%), only pituitary stalk (6.7%), only hypothalamus (13.3%), and only clivus (3.3%) were observed. In hypothalamus-pituitary dysfunction, both anterior and posterior dysfunction (20.7%), only anterior dysfunction (58.6%), only posterior dysfunction (3.4%), and no dysfunction (17.2%) were observed. It seemed that hypothalamic lesion is related to both anterior and posterior dysfunction, while sellar lesion is related to mainly anterior dysfunction. In cranial nerve dysfunction, 2nd nerve dysfunction (45.2%) and 6th nerve dysfunction (35.5%) were frequently observed. It seemed that sellar lesion is related to both 2nd and 6th nerve dysfunction, while hypothalamic lesion is related to mainly 2nd nerve dysfunction.
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Affiliation(s)
- Mutsuko Yasuda
- Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Koutoh-bashi, Sumida-ku, 130-8575, Tokyo, Japan
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