Case Report: Primary pituitary non-Hodgkin’s lymphoma developed following surgery and radiation of a pituitary macroadenoma

Papanastasiou, Labrini; Παππά, Θεοδώρα; Dasou, Aikaterini; Kyrodimou, Efi; Kontogeorgos, George; Samara, Christianna; Bacaracos, Panagiotis; Galanopoulos, Athanasios; Piaditis, George

doi:10.14310/horm.2002.1382

Cited by 10 publications

(3 citation statements)

References 26 publications

(20 reference statements)

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“…Such a frequent involvement of the posterior pituitary should be paid more attention. Distinct radiological features were not identified in the sellar and suprasellar lymphomas ( 29 ). Therefore, the pathological analysis was required to confirm the diagnosis and adjust the treatment.…”

Section: Discussionmentioning

confidence: 96%

“…PPL may either derive from neoplastic transformation of normal lymphocytes that enter the CNS due to inflammatory processes or from the transformation of normal resident lymphoid tissue in the CNS ( 2 , 28 ). Also, some multipotent cells, i.e., chromophobes, marginal zone cells, follicular cells, folliculo stellate cells, and colony-forming units, might activate and proliferate to develop pituitary lymphoma ( 29 ). Risk factors, including AIDS and other immunodeficiency states, along with lymphocytic hypophysitis and pituitary adenomas increase the susceptibility to PPL ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

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Primary Pituitary Lymphoma in Immunocompetent Patients: A Report on Two Case Studies and the Review of Literature

et al. 2021

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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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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Primary Pituitary Lymphoma in Immunocompetent Patients: A Report on Two Case Studies and the Review of Literature

et al. 2021

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“…Regarding the other malignant entities in this patient, including DLBCL, Hurthle cell adenoma, and low-grade NET, these may be secondary to RT for Hodgkin lymphoma, as they do fulfill Cahan’s criteria. Thyroid malignancies secondary to RT including Hurthle cell adenoma are well-described, and there are reports of DLBCL secondary to radiation[16-18]. A case of quadruple neoplasms following RT therapy has also been published[19].…”

Section: Discussionmentioning

confidence: 99%

Radiation-associated epithelial-myoepithelial carcinoma among five secondary malignancies: A case report and review of literature

Khattab

Sherry

Ahlers

et al. 2018

WJCO

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BACKGROUNDEpithelial-myoepithelial carcinoma (EMC) is a rare, low-grade, malignant tumor that constitutes less than one percent of all salivary gland tumors. To date, only one other case report has described radiation-associated EMC in the English language medical literature.CASE SUMMARYIn this report, we describe the case of a 56-year-old male patient who presented with a neck mass diagnosed as EMC of the left submandibular gland approximately 30 years after mantle field radiation and chemotherapy for Hodgkin lymphoma. Treatment included resection, re-resection with nodal dissection, and adjuvant chemoradiotherapy. This patient was also diagnosed with 4 other secondary malignancies, including stage IV diffuse large B cell lymphoma in the abdomen with subsequent brain metastases, low-grade neuroendocrine carcinoma of the lung, Hurthle cell adenoma, and small B cell lymphoma before the patient expired. This case provides important information regarding the pathology, clinical sequelae, and management of a patient diagnosed with radiation-associated EMC amidst four concurrent malignancies.CONCLUSIONFurther investigation is needed on the efficacy of adjuvant radiotherapy in EMC, especially atypical EMC.

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Primary pituitary lymphoma: an update of the literature

et al. 2016

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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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Case Report: Primary pituitary non-Hodgkin’s lymphoma developed following surgery and radiation of a pituitary macroadenoma

Cited by 10 publications

References 26 publications

Primary Pituitary Lymphoma in Immunocompetent Patients: A Report on Two Case Studies and the Review of Literature

Primary Pituitary Lymphoma in Immunocompetent Patients: A Report on Two Case Studies and the Review of Literature

Radiation-associated epithelial-myoepithelial carcinoma among five secondary malignancies: A case report and review of literature

Primary pituitary lymphoma: an update of the literature

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