Chronic Lymphocytic Leukemia Presenting as a Pituitary Mass Lesion

Abstract

ABSTRACT:We describe a unique case of chronic lymphocytic leukemia (CLL) in a patient who presented with bitemporal hemianopsia, adrenal insufficiency, and gonadotrophin deficiency. Studies revealed an enhancing intrasellar mass with suprasellar extension and displacement of the optic chiasm. Peripheral blood and cerebrospinal fluid (CSF) studies disclosed a monoclonal IgM kappa expressing B-cell CLL. Biopsy of the pituitary mass revealed dense infiltration of the pituitary gland by leukemic cells. This is, to our knowledge, the first reported case of CLL presenting as a pituitary mass lesion.

Chronic lymphocytic leukemia with central nervous system involvement: report of two cases with a comprehensive literature review

“…In the Getaz and Miller [23] case, response to radiation was supervened by a seemingly unrelated cardiovascular event. Fain et al [20] report a case treated with pituitary surgical resection; although symptoms were resolved, long-term survival was not reported.…”

Leptomeningeal Involvement in Chronic Lymphocytic Leukemia

“…Cranial nerve VI has been the nerve most frequently implicated, 13, 15, 17 with resultant extraocular eye movement deficits; however, V 18 and VII nerve palsies 15 have been described as well. Deafness was evident in two cases, 9, 15 unilateral vision loss in two cases, 18, 19 and optic atrophy with central scotomas in one. 20 Optic neuropathy was reported in three patients by one group of researchers.…”

“…Although more than 200,000 cases of CLL have been reported in the past 20 years, only 21 cases of symptomatic CNS involvement have been diagnosed premorbidly ( Table 1). 9, –24, Presenting CNS symptoms are heterogeneous, and suspicion of CNS involvement is low, causing delays in or deterring diagnosis.…”

Leukaemic infiltration of gall bladder – unusual presentation of occult chronic lymphocytic leukaemia

“…Common sites of extramedullary involvement include the lymph nodes and spleen. Unusual cases of early stage CLL with infiltration into prostate, pituitary, myocardium, thyroid, lung, and orbit have been reported (2,3,4,5). …”