Pituitary infiltration of non-Hodgkin's lymphoma: a case report
IntroductionPituitary adenomas represent the most frequently observed type of sellar masses; however, a rapidly growing sellar tumor, diabetes insipidus, ophthalmoplegia and headaches in an old patient strongly suggest metastasis to the pituitary. Since the anterior pituitary has a great reserve capacity, metastasis to the pituitary and pituitary involvement in lymphoma are usually asymptomatic.
Whereas diabetes insipidus is the most frequent symptom, sometimes as a result of the extension of the mass, patients can present with headaches, ophthalmoplegia and bilateral hemianopsia.Case presentationA 70-year-old female patient with no previous history of malignancy presented with headaches, right oculomotor nerve palsy and diabetes insipidus. As magnetic resonance imaging revealed a sellar mass involving the pituitary gland and infundibular stalk, which also extended into the right cavernous sinus and sphenoid sinus, the patient was subjected to an immediate transsphenoidal decompression surgery.
Her prolactin was 102.4ng/ml whereas her gonadotropic hormone levels were low. A low level of urine osmolality after an overnight water deprivation, along with normal plasma osmolality suggested diabetes insipidus.
Histological examination revealed that the mass had been the infiltration of a high grade B-cell non-Hodgkin's lymphoma involving respiratory system epithelial cells. Paranasal sinus computed tomography scanning and magnetic resonance imaging of the thorax and abdomen were performed.
Since magnetic resonance imaging did not reveal any abnormality, after paranasal sinus computed tomography was performed, we concluded that the primary lymphoma originated from the sphenoid sinus and infiltrated the pituitary. Chemotherapy and radiotherapy to the sellar area were planned, but the patient died and her family did not permit an autopsy.
Conclusion: Lymphoma infiltration to the pituitary is difficult to differentiate from pituitary adenoma, meningioma and other sellar lesions.
To plan the treatment of lymphoma infiltration of the pituitary gland, it must be differentiated from other sellar lesions.
Author: Gonca TamerIlkay KartalFerihan Aral
Credits/Source: Journal of Medical Case Reports 2009, 3:9293
Published on: 2009-11-24
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
make sure to read our disclaimer prior to contacting 7thSpace Interactive. To contact our editors, visit our online helpdesk. If you wish submit your own press release, click here.
Social Bookmarking
RETWEET This! | Digg this! | Post to del.icio.us | Post to Furl | Add to Netscape | Add to Yahoo! | Rojo
|
|
