Primary Hypothalamic Lymphoma in an Adult Male: A Case Report and Literature Review

Tanki, Humam; Malik, Khursheed Nayil; Makhdoomi, Rumana; Shaheen, Feroze; Ramzan, Altaf

doi:10.5001/omj.2018.63

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…Sellar or suprasellar lymphomatous masses have been described previously in cats, 19,20,57 although ependymal enhancement has not been reported. Lymphomatous infiltration of the hypothalamus and third ventricle, with or without infiltration of the hypophysis, optic chiasm, cavernous sinus and associated cranial nerves, is a rare but well described entity in human patients 58‐60 . This infiltrative behavior may help to differentiate lymphoma from other sellar or suprasellar masses such as pituitary adenoma or carcinoma, although further study would be warranted for confirmation.…”

Section: Discussionmentioning

confidence: 98%

“…22,59.1%; Figure1), and multiple spinal compartments (extradural, intradural, intramedullary, or some combination of these)F I G U R E 1 Transverse T2w (A, E, I), dorsal (B) and transverse FLAIR (F, J), transverse pre-(C, G, K) and postcontrast (D, H, L) T1w magnetic resonance images of feline nervous system lymphoma classified as extra-axial (A-D), intra-axial (E-H), and both extra-and intra-axial (I-L). (A-D) An invasive ill-defined extra-axial T2w hyperintense, FLAIR isointense, T1w hypointense heterogeneously contrast enhancing extra-axial mass (asterisk) is present along the left side of the brainstem and invades the ipsilateral tympanic cavity (black star).…”

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confidence: 99%

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Clinical and magnetic resonance imaging features of lymphoma involving the nervous system in cats

Durand

Keenihan

Schweizer

et al. 2022

Veterinary Internal Medicne

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Background Lymphoma is the most common spinal cord neoplasm and second most common intracranial tumor in cats, but description of specific magnetic resonance imaging (MRI) features is lacking. Objective Describe the clinical and MRI features of lymphoma affecting the central (CNS) or peripheral (PNS) nervous system or both in cats. Animals Thirty‐one cats with confirmed cytological or histopathological diagnosis or both of lymphoma involving the CNS or PNS or both, and MRI findings of the lesions. Methods Multicenter retrospective descriptive study. Signalment and medical information were recorded. Magnetic resonance imaging findings were reviewed by 3 observers following a list of predefined criteria and consensus was sought. Frequency distributions of the different categorical data were reported. Results Median duration of clinical signs at time of presentation was 14 days (range, 1‐90). Neurological examination was abnormal in 30/31 cats. On MRI, lesions affecting the CNS were diagnosed in 18/31 cats, lesions in both CNS and PNS in 12/31, and lesions in the PNS only in 1/31. Intracranial lesions were diagnosed in 22 cats (extra‐axial, 7/22; intra‐axial, 2/22; mixed, 13/22), and spinal lesions were diagnosed in 12 (6/12 involving the conus medullaris and lumbosacral plexuses). Infiltration of adjacent extra‐neural tissue was present in 11/31 cases. Contrast enhancement was seen in all lesions, being marked in 25/30. Meningeal enhancement was present in all but 2 cases. Several distinct MRI patterns were observed. Conclusions and Clinical Importance Nervous system lymphoma in cats has a wide range of MRI features, of which none is pathognomonic. However, together with clinical data and cerebrospinal fluid (CSF) analysis, MRI may provide a strong tentative antemortem diagnosis.

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

Clinical and magnetic resonance imaging features of lymphoma involving the nervous system in cats

Durand

Keenihan

Schweizer

et al. 2022

Veterinary Internal Medicne

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“…Initial symptoms may include subclinical intracranial pressure and psychiatric conditions in addition to other conditions originating in the brain such as paralysis and aphasia [ 5 ]. PCNSL with hypothalamic-pituitary lesions has been rarely reported [ 6 ]. Here we report a case of PCNSL with the primary lesion in the hypothalamus, which was found by magnetic resonance imaging (MRI) after sudden onset of endocrinological abnormalities.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and treatment of primary central nervous system lymphoma with the primary lesion in the hypothalamus: a case report

et al. 2021

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Background Primary central nervous system lymphoma is a rare extra-nodal lymphoma of the central nervous system. Primary central nervous system lymphoma lesions usually appear in the vicinity of the ventricle, and there are few reports of primary central nervous system lymphoma with hypothalamic-pituitary lesions. Case presentation We treated a 56-year-old male with primary central nervous system lymphoma with the primary lesion in the hypothalamus, which was found by magnetic resonance imaging after sudden onset of endocrinological abnormalities. Initially, he was hospitalized to our department for hyponatremia. Endocrinological examination in conjunction with head magnetic resonance imaging and endoscopic biopsy revealed hypothalamic hypopituitarism and tertiary hypoadrenocorticism caused by a rapidly growing, diffuse large B-cell lymphoma in the hypothalamus. Remission of the tumor was achieved by high-dose methotrexate with whole brain radiotherapy, and some of the hormone responses were normalized. Conclusions While primary central nervous system lymphoma is rare, it is important to note that hypopituitarism can result and that the endocrinological abnormalities can be partially restored by its remission.

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“…Pituitary macroadenoma, craniopharyngioma, meningioma, metastasis, hamartoma, glioma and granulomatous diseases such as sarcoidosis and tuberculosis are some of lesions which involve the hypothalamus and the third ventricular region [ 6 ]. Scans of the chest, abdomen and pelvis were negative for any primary tumor in our patient.…”

Section: Discussionmentioning

confidence: 99%

Primary hypothalamic lymphoma with clinical findings mimicking pituitary apoplexy: a case report

et al. 2021

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Background Primary central nervous system lymphoma (PCNSL) is a rare but well-known extra-nodal lymphoma, which usually presents with non-Hodgkin B-cell lymphomas. PCNSL is generally located around the ventricle and is often detected as multiple lesions. It is rarely seen in the area of the hypothalamus. Case presentation We report the case of a 48-year-old Caucasian woman with progressive short-term memory deterioration, headache, mental confusion, diabetes insipidus (DI) and hypopituitarism. Early findings were suggestive of a pituitary apoplexy. The results of tests performed during the initial admission at the tertiary health center revealed hypernatremia, hypopituitarism and DI. Intravenous hydrocortisone treatment was initiated for the secondary adrenal insufficiency, and 75 mcg/day of levothyroxine was started for the secondary hypothyroidism on the fourth day following hydrocortisone treatment. A daily dose of 120 mg desmopressin melt tablet was started twice a day for polyuria/polydipsia after the patient’s volume status was balanced. A brain magnetic resonance imaging scan revealed a mass lesion in the hypothalamic area, which was surrounded by marked edema. Anti-edema treatment was initially started considering the suggestion by our neurosurgery team. The patient’s clinical and laboratory findings improved after the initiation of the anti-edema therapy. Afterwards, a biopsy was performed, which diagnosed a malignant diffuse large B-cell lymphoma. Subsequently, intravenous high-dose methotrexate-based therapy was started; however, after the second cycle of chemotherapy, the patient died due to sepsis. Conclusion In this report, we present a case of hypopituitarism that developed due to the mass effect of hypothalamic lymphoma with clinical findings of pituitary apoplexy. Intracranial masses may cause obvious endocrinological findings related to hypopituitarism, while vague findings may also be observed due to partial failure. Therefore, it is important to perform a comprehensive endocrinological examination at the time of diagnosis in patients with intracranial masses.

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Primary Hypothalamic Lymphoma in an Adult Male: A Case Report and Literature Review

Cited by 9 publications

References 20 publications

Clinical and magnetic resonance imaging features of lymphoma involving the nervous system in cats

Clinical and magnetic resonance imaging features of lymphoma involving the nervous system in cats

Diagnosis and treatment of primary central nervous system lymphoma with the primary lesion in the hypothalamus: a case report

Primary hypothalamic lymphoma with clinical findings mimicking pituitary apoplexy: a case report

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