Abstract
Lymphoma is one of the causative factors of hypothalamus–pituitary dysfunction, and intravascular large B-cell lymphoma (IVLBCL) is a subtype of primary extranodal neoplasm. A 69-year-old woman visited our hospital because of general fatigue. We diagnosed her with presumable non-functional primary pituitary adenoma and subsequent dysfunction. Eight months after, the patient revisited our hospital because of dyspnea. Though we conducted systemic investigations including chest and abdomen enhanced computer tomography, transbronchial lung biopsy, and bone marrow biopsy, the diagnosis was not confirmed. Inadvertently, a breast cancer was found, and the surgical specimen proved that the patient had double cancer—adenocarcinoma and IVLBCL. Rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone regimen was initiated, and complete remission was achieved. Notably, the sellar mass returned to normal size with improved function. We reviewed 32 patients with primary parasellar lymphoma. In affected sites, both sellar and pituitary stalk (6.7%), both hypothalamus and pituitary stalk (6.7%), only sellar (63.3%), only pituitary stalk (6.7%), only hypothalamus (13.3%), and only clivus (3.3%) were observed. In hypothalamus–pituitary dysfunction, both anterior and posterior dysfunction (20.7%), only anterior dysfunction (58.6%), only posterior dysfunction (3.4%), and no dysfunction (17.2%) were observed. It seemed that hypothalamic lesion is related to both anterior and posterior dysfunction, while sellar lesion is related to mainly anterior dysfunction. In cranial nerve dysfunction, 2nd nerve dysfunction (45.2%) and 6th nerve dysfunction (35.5%) were frequently observed. It seemed that sellar lesion is related to both 2nd and 6th nerve dysfunction, while hypothalamic lesion is related to mainly 2nd nerve dysfunction.
Similar content being viewed by others
References
Jaffe ES, Harris NL, Stein H et al (2001) WHO classification of tumors, pathology and genetics, tumors of hematopoietic and lymphoid tissues. IARC Press, Lyon, pp 177–178
Ferreri AJ, Campo E, Seymour JF, Willemze R, Ilariucci F, Ambrosetti A, Zucca E, Rossi G, López-Guillermo A, Pavlovsky MA, Geerts ML, Candoni A, Lestani M, Asioli S, Milani M, Piris MA, Pileri S, Facchetti F, Cavalli F, Ponzoni M; International Extranodal Lymphoma Study Group (IELSG) (2004) Intravascular lymphoma: clinical presentation, natural history, management and prognostic factors in a series of 38 cases, with special emphasis on the ‘cutaneous variant’. Br J Haematol 127(2):173–183
Demirer T, Dail DH, Aboulafia DM (1994) Four varied cases of intravascular lymphomatosis and a literature review. Cancer 73(6):1738–1745
Kraus MD, Jones D, Bartlett NL (1999) Intravascular lymphoma associated with endocrine dysfunction: a report of four cases and a review of the literature. Am J Med 107(2):169–176
Wick MR, Mills SE, Scheithauer BW, Cooper PH, Davitz MA, Parkinson K (1986) Reassessment of malignant “angioendotheliomatosis”. Evidence in favor of its reclassification as “intravascular lymphomatosis”. Am J Surg Pathol 10(2):112–123
Shanks JH, Harris M, Howat AJ, Freemont AJ (1997) Angiotropic lymphoma with endocrine involvement. Histopathology 31(2):161–166
Ponzoni M, Ferreri AJ, Campo E, Facchetti F, Mazzucchelli L, Yoshino T, Murase T, Pileri SA, Doglioni C, Zucca E, Cavalli F, Nakamura S (2007) Definition, diagnosis, and management of intravascular large B-cell lymphoma: proposals and perspectives from an international consensus meeting. J Clin Oncol 25(21):3168–3173
Matsue K, Asada N, Takeuchi M, Yamakura M, Kimura S, Odawara J, Aoki T (2008) A clinicopathological study of 13 cases of intravascular lymphoma: experience in a single institution over a 9-yr period. Eur J Haematol 80(3):236–244
Taura Y, Yamazaki H, Katou T (2000) Two cases of intravascular lymphomatosis diagnosed antemortem by transbronchial lung biopsy. Nihon Kokyuki Gakkai Zasshi 38(1):34–38
Narimatsu H, Morishita Y, Saito S, Shimada K, Ozeki K, Kohno A, Kato Y, Nagasaka T (2004) Usefulness of bone marrow aspiration for definite diagnosis of Asian variant of intravascular lymphoma: four autopsied cases. Leuk Lymphoma 45(8):1611–1616
Murase T, Yamaguchi M, Suzuki R, Okamoto M, Sato Y, Tamaru J, Kojima M, Miura I, Mori N, Yoshino T, Nakamura S (2007) Intravascular large B-cell lymphoma (IVLBCL): a clinicopathologic study of 96 cases with special reference to the immunophenotypic heterogeneity of CD5. Blood. 109(2):478–485
Motegi S, Tamura A, Takeuchi Y, Ishikawa O (2004) Senile angioma-like eruption: a skin manifestation of intravascular large B cell lymphoma. Dermatology 209(2):135–137
Asada N, Odawara J, Kimura S, Aoki T, Kamakura M, Takeuchi M, Seki R, Tanaka A, Matsue K (2007) Use of random skin biopsy for diagnosis of intravascular large B-cell lymphoma. Mayo Clin Proc 82(12):1525–1527
Saito T, Nakahara T, Abe Y, Sugiura T, Ogata M, Sugiyama Y, Watanabe T, Honma M, Hida C, Yamamoto T (1998) A 63-year-old man with progressive cauda equina/conus medullaris syndrome. No To Shinkei 50(12):1133–1141
Hoshino A, Kawada E, Ukita T, Itoh K, Sakamoto H, Fujita K, Mantani N, Kogure T, Tamura J (2004) Usefulness of FDG-PET to diagnose intravascular lymphomatosis presenting as fever of unknown origin. Am J Hematol 76(3):236–239
Mathiasen RA, Jarrahy R, Cha ST, Kovacs K, Herman VS, Ginsberg E, Shahinian HK (2000) Pituitary lymphoma: a case report and literature review. Pituitary 2(4):283–287
Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R, Morel P, Van Den Neste E, Salles G, Gaulard P, Reyes F, Lederlin P, Gisselbrecht C (2002) CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 346(4):235–242
Shimada K, Matsue K, Yamamoto K, Murase T, Ichikawa N, Okamoto M, Niitsu N, Kosugi H, Tsukamoto N, Miwa H, Asaoku H, Kikuchi A, Matsumoto M, Saburi Y, Masaki Y, Yamaguchi M, Nakamura S, Naoe T, Kinoshita T (2008) Retrospective analysis of intravascular large B-cell lymphoma treated with rituximab-containing chemotherapy as reported by the IVL study group in Japan. J Clin Oncol 26(19):3189–3195
Sautner D, Saeger W, Lüdecke DK (1993) Tumors of the sellar region mimicking pituitary adenomas. Exp Clin Endocrinol 101(5):283–289
Freda PU, Post KD (1999) Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am 28:81–117
Gsponer J, De Tribolet N, Déruaz JP, Janzer R, Uské A, Mirimanoff RO, Reymond MJ, Rey F, Temler E, Gaillard RC, Gomez F (1999) Diagnosis, treatment, and outcome of pituitary tumors and other abnormal intrasellar masses. Retrospective analysis of 353 patients. Medicine (Baltimore) 78(4):236–269
Singh VP, Mahapatra AK, Dinde AK (1993) Sellar-suprasellar primary malignant lymphoma: case report. Indian J Cancer 30(2):88–91
Singh S, Cherian RS, George B, Nair S, Srivastava A (2000) Unusual extra-axial central nervous system involvement of non-Hodgkin’s lymphoma: magnetic resonance imaging. Australas Radiol 44(1):112–114
Shaw JA, Strachan FM, Sawers HA, Bevan JS (1997) Non-Hodgkin lymphoma with panhypopituitarism, hyperprolactinaemia and sixth nerve palsy. J R Soc Med 90(5):274–275
Roggli VL, Suzuki M, Armstrong D, McGavran MH (1979) Pituitary microadenoma and primary lymphoma of brain associated with hypothalamic invasion. Am J Clin Pathol 71(6):724–727
Landman RE, Wardlaw SL, McConnell RJ, Khandji AG, Bruce JN, Freda PU (2001) Pituitary lymphoma presenting as fever of unknown origin. J Clin Endocrinol Metab 86(4):1470–1476
Baleydier F, Galambrun C, Manel AM, Guibaud L, Nicolino M, Bertrand Y (2001) Primary lymphoma of the pituitary stalk in an immunocompetent 9-year-old child. Med Pediatr Oncol 36(3):392–395
Kaufmann TJ, Lopes MB, Laws ER Jr, Lipper MH (2002) Primary sellar lymphoma: radiologic and pathologic findings in two patients. AJNR Am J Neuroradiol 23(3):364–367
Capra M, Wherrett D, Weitzman S, Dirks P, Hawkins C, Bouffet E (2004) Pituitary stalk thickening and primary central nervous system lymphoma. J Neurooncol 67(1–2):227–231
Rudnik A, Larysz D, Blamek S, Larysz P, Bierzyńska-Macyszyn G, Właszczuk P, Bazowski P (2007) Primary pituitary lymphoma. Folia Neuropathol 45(3):144–148
Layden BT, Dubner S, Toft DJ, Kopp P, Grimm S, Molitch ME (2009) Primary CNS lymphoma with bilateral symmetric hypothalamic lesions presenting with panhypopituitarism and diabetes insipidus. Pituitary. http://www.ncbi.nlm.nih.gov/pubmed/19123039?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Quintero Wolfe S, Hood B, Barker J, Benveniste RJ (2009) Primary central nervous system lymphoma mimicking pituitary apoplexy: case report. Pituitary 12(1):76–79
Scully RE, Mark EJ, McNeely WF, McNeely BU (1994) Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises Case 36-1994. A 49-year-old man with hypopituitarism, multifocal neurologic defects, and an intracranial mass. N Engl J Med 331(13):861–868
Gottfredsson M, Oury TD, Bernstein C, Carpenter C, Bartlett JA (1996) Lymphoma of the pituitary gland: an unusual presentation of central nervous system lymphoma in AIDS. Am J Med 101(5):563–564
Matsuda M, Hattori T, Tabata K, Seki S (1999) A case of non-Hodgkin lymphoma in the central nervous system, developing during treatment of galactorrhea amenorrhea syndrome. Rinsho Shinkeigaku 39(11):1160–1163
Au WY, Kwong YL, Shek TW, Leung G, Ooi C (2000) Diffuse large-cell B-cell lymphoma in a pituitary adenoma: an unusual cause of pituitary apoplexy. Am J Hematol 63(4):231–232
Tsai VW, Rybak L, Espinosa J, Kuhn MJ, Kamel OW, Mathews F, Glatz FR (2002) Primary B-cell lymphoma of the clivus: case report. Surg Neurol 58(3–4):246–250
Lee MT, Lee TI, Won JG, Chau WK, Yang HJ, Li JC, Lin HD, Tang KT (2004) Primary hypothalamic lymphoma with panhypopituitarism presenting as stiff-man syndrome. Am J Med Sci 328(2):124–128
Chen SM, Chang CN, Wei KC, Jung SM, Chuang CC (2008) Sellar lymphoma mimicking sphenoid infection presenting with cavernous sinus syndrome. J Clin Neurosci 15(10):1148–1151
Moshkin O, Muller P, Scheithauer BW, Juco J, Horvath E, Patterson BJ, Kamel-Reid S, Kovacs K (2009) Primary pituitary lymphoma: a histological, immunohistochemical, and ultrastructural study with literature review. Endocr Pathol 20(1):46–49
Samaratunga H, Perry-Keene D, Apel RL (1997) Primary lymphoma of pituitary gland: a neoplasm of acquired malt? Endocr Pathol 8(4):335–341
Lee JH, Lee HK, Choi CT, Huh J (2002) Mucosa-associated lymphoid tissue lymphoma of the pituitary gland: MR imaging features. AJNR Am J Neuroradiol 23(5):838–840
Silfen ME, Garvin JH Jr, Hays AP, Starkman HS, Aranoff GS, Levine LS, Feldstein NA, Wong B, Oberfield SE (2001) Primary central nervous system lymphoma in childhood presenting as progressive panhypopituitarism. J Pediatr Hematol Oncol 23(2):130–133
Kozáková D, Macháleková K, Brtko P, Szépe P, Vanuga P, Pura M (2008) Primary B-cell pituitary lymphoma of the Burkitt type: case report of the rare clinic entity with typical clinical presentation. Cas Lek Cesk 147(11):569–573
Katz BJ, Jones RE, Digre KB, Warner JE, Moore KR (2003) Panhypopituitarism as an initial manifestation of primary central nervous system non-Hodgkin’s lymphoma. Endocr Pract 9(4):296–300
Sakakibara Y, Matsuzawa M, Taguchi Y, Sekino H, Shinagawa T, Abe M, Tadokoro M (1998) A case of sellar T cell type malignant lymphoma. No Shinkei Geka 26(1):53–58
Huang YY, Lin SF, Dunn P, Wai YY, Hsueh C, Tsai JS (2005) Primary pituitary lymphoma presenting as hypophysitis. Endocr J 52(5):543–549
Liu JK, Sayama C, Chin SS, Couldwell WT (2007) Extranodal NK/T-cell lymphoma presenting as a pituitary mass. Case report and review of the literature. J Neurosurg 107(3):660–665
Romeike BF, Joellenbeck B, Stein H, Loddenkemper C, Hummel M, Firsching R, Mawrin C (2008) Precursor T-lymphoblastic lymphoma within a recurrent pituitary adenoma. Acta Neurochir (Wien) 150(8):833–836
Kuhn D, Buchfelder M, Brabletz T, Paulus W (1999) Intrasellar malignant lymphoma developing within pituitary adenoma. Acta Neuropathol 97(3):311–316
Fisher SG, Fisher RI (2004) The epidemiology of non-Hodgkin’s lymphoma. Oncogene 23(38):6524–6534
Svajdler M, Lazúrová I, Bohus P, Pal’ko M (2006) Intravascular variant of diffuse large B-cell lymphoma with combined endocrine involvement. Wien Klin Wochenschr 118(13–14):422–425
Pekic S, Milicevic S, Colovic N, Colovic M, Popovic V (2008) Intravascular large B-cell lymphoma as a cause of hypopituitarism: gradual and late reversal of hypopituitarism after long-term remission of lymphoma with immunochemotherapy. Endocrine 34(1–3):11–16
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yasuda, M., Akiyama, N., Miyamoto, S. et al. Primary sellar lymphoma: intravascular large B-cell lymphoma diagnosed as a double cancer and improved with chemotherapy, and literature review of primary parasellar lymphoma. Pituitary 13, 39–47 (2010). https://doi.org/10.1007/s11102-009-0196-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11102-009-0196-9