Lymphoma Metastasizing to the Pituitary: An Unusual Presentation of a Treatable Disease
- 178 Downloads
Lymphoma involving the pituitary gland is particularly rare. We present two cases of patients with pituitary lymphoma, both of whom were symptomatic from pituitary dysfunction. The first patient demonstrated pituitary involvement on imaging, with mild biochemical diabetes insipidus but clear hypoadrenalism. Both adrenals were grossly enlarged on CT scanning and biopsy of one of the adrenal masses confirmed the diagnosis of diffuse large B cell lymphoma. The second patient presented with clinical diabetes insipidus but with no obvious abnormalities on pituitary imaging. CT scanning of abdomen and pelvis, however, revealed widespread lymphadenopathy. Lymph node biopsy revealed a T cell-rich B cell lymphoma.
Review of the English-language literature of all published cases of pituitary lymphoma in the presence of generalised disease in immunocompetent patients revealed 13 cases. Most patients had large B cell non-Hodgkin's lymphoma. Involvement of the anterior lobe of the pituitary was more frequently seen than in patients developing pituitary metastases from solid tumour primaries. Patients with advanced lymphoma including the pituitary also appear to have a better prognosis than patients presenting with pituitary metastases. This is an important diagnosis to make as rapidly as possible to allow the early institution of effective therapy.
Key wordslymphoma pituitary adrenal
Unable to display preview. Download preview PDF.
- 1.Komninos J, Vlassopoulou V, Protopapa D, Korfias S, Kontogeorgos, Sakas DE, Thalassinos NC. Tumors metastatic to the pituitary gland: case report and literature review. J. Clin Endo Metabol 2004;89:574–580.Google Scholar
- 4.Fjellustad-Paulsen A, Wille S, Harris AS. Comparison of intranasal and oral desmopressin for nocturnal diuresis. Arch Dis Child 1987;62:674–674.Google Scholar
- 6.Ferrara P, Piersigilli F, Ruggiero A, Chiozza ML, Salvatore S. Two different desmopressin (DDAVP) regimens in enuretic monozygotic twins with allergic diathesis. Scand J Urol Nephrol 1999;34:203–204.Google Scholar
- 7.Branch CL, Laws ER. Metastatic tumors of the sella turcica masquerading as primary pituitary tumors. J Clin Endo Metabol 1987;65:469–474.Google Scholar
- 9.Giustina A, Gola M, Doga M, Rosei EA. Primary lymphoma of the pituitary: an emerging clinical entity. J Clin Endo Metabol 2001;86:4567–4575.Google Scholar
- 10.Sheehan T, Cuthbert RJ, Parker AC. Central nervous system involvement in haematological malignancies. Clin lab Haemat 1989;11:331–338.Google Scholar
- 12.Matsuda M, Hatori T, Tabata K, Seki S. A case of non Hodgkins lymphoma in the central nervous system, developing during treatment of galactorrhoea, amenorrhoea syndrome. Rinko Shinkeigakm 1999;39:1160–1163.Google Scholar
- 14.Basaria S, Krop J, Braga-Basaria M. A rare cause of pituitary stalk enlargement and panhypopituitarism. Mt S J Med 2003;70:265–267.Google Scholar
- 17.Ashigbi MY, Venkatraj U, Agrawal V, Bello J, Wiernik PH. Intracranial hodgkin's disease in two patients with familial hodgkin's disease. Med Pediat Oncol 1997;29:255–258.Google Scholar
- 18.Mathiasen RA, Jarrahy R, Cha ST, Kovacs K, Herman VS, Ginsberg E, Shahinian HK. Pituitary lymphoma: a case report and literature review. Pituitary 2000;4:283–287.Google Scholar
- 19.Leedman PJ, Matz LR, Pullan P. Endocrine dysfunction in lymphomatoid granulomatosis. Aust NZ J Med 1989;19:761–765.Google Scholar
- 20.Bushunow PW, Casas V, Duggan DB. Lymphomatoid granulomatosis causing central diabetes insipidus: case report and review of the literature. Cancer Investig 1996;14:112–119.Google Scholar
- 23.Breidert M, Schimmerlpfennig C, Kittner T, Helwig A, Ehninger G. Diabetes insipidus in a patient with a highly malignant B-cell lymphoma and stomatitis. Exp Clin Endocrinol Diabetes 1999;107:54–58.Google Scholar
- 24.Buchler T, Ferra C, Virgili N, Montanya E, Granena A. A relapsed non-Hodgkin's lymphoma presenting as panhypopituitarism successfully by chemotherapy. J Neuro Oncol 2002;59:35–38.Google Scholar