Acromegaly and Large Cell Lymphoma

The Coexistence of an Intrasellar Adenoma, Lymphocytic Hypophysitis, and Primary Pituitary Lymphoma in a Patient with Acromegaly

“…Some etiologic theories suggest that the tumor may arise from resident lymphoid tissue in the CNS, while others consider the possibility of normal lymphocytes migrating to the sellar region due to inflammatory processes and subsequently undergoing malignant transformation [3, 13]. This malignant transformation could be attributed to the presence of GH, IGF-I, IGF-II, and insulin receptors as they have been recognized on normal lymphocytes and on human lymphoblasts [3, 4, 20]. In our case the idea of migrating lymphocytes with further malignant transformation should be highly entertained due to the patient's medical history of Hashimoto's thyroiditis and breast cancer (both with an inflammatory component).…”

“…Since in our patient immunostains of the adenomatous component was negative for all anterior pituitary hormones, one plausible explanation is the role of the tumor itself in the basal production of GH-dependent factors, thus contributing to the neoplastic transformation of cells and the clinical manifestation of acromegaly. Immunoreactivity has established the production of GH and IGF-I by lymphoblasts and lymphocytes [3, 22]. In addition, the recognition of somatostatin receptors on malignant lymphomas has been reported [2, 23].…”

“…Typical features range from subtle signs including thickening of the skin, enlargement of hands, feet, and mandible, and visceromegaly to other florid systemic conditions such as heart failure [2]. GH-dependent factors, such as insulin-like growth factor-I (IGF-I) or somatomedin C, not only have been associated with the classic clinical manifestations of acromegaly but also may be implicated in the increased risk of developing neoplasia [1, 3]. In addition to colon cancer, patients with acromegaly are prone to develop lymphoproliferative cancers such as lymphoma or leukemia [1–3].…”

“…GH-dependent factors, such as insulin-like growth factor-I (IGF-I) or somatomedin C, not only have been associated with the classic clinical manifestations of acromegaly but also may be implicated in the increased risk of developing neoplasia [1, 3]. In addition to colon cancer, patients with acromegaly are prone to develop lymphoproliferative cancers such as lymphoma or leukemia [1–3]. The most probable mechanism explaining the above is the close structural homology of these peptides with insulin, therefore stimulating mitogenesis and cellular growth [4].…”

Hodgkin Lymphoma in Temporal Association with Growth Hormone Replacement

“…Acromegaly, a state of excessive GH or IGF-1, has been associated with solitary benign and malignant tumors such as colon cancer [16][17][18][19], There are case reports of non-Hodgkin lymphoma and leukemia in patients with acromegaly [20]. GH levels, both basal and hypoglycaemia induced, were found to be higher in patients with hematologic malignancies including 33 subjects with Hodgkin lymphoma [21].…”