Abstract
We report a 14-year-old girl in whom a diagnosis of primary central nervous system lymphoma was confirmed while receiving growth hormone (GH) for GH deficiency, detected after presenting with short stature. MRI revealed an enhancing and thickened pituitary stalk with absence of the normal bright signal in the posterior pituitary. Regular MRI surveillance detected progression of the neurohypophyseal changes 13 months into GH treatment. Biopsy confirmed this to be B-cell large cell lymphoma. This case highlights the diagnostic and management challenges inherent in treating such children.
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Watanabe S, Mizuno S, Oshima LH, Tsunematsu Y, Fujimoto J, Komiyama A: Leukemia and other malignancies among GH users. J Pediatr Endocrinol 6: 99–108, 1993
Fradkin JE, Mills JL, Schonberger LB, Wysowski DK, Thomson R, Durako SJ, Robison LL: Risk of leukemia after treatment with pituitary growth hormone. JAMA 270: 2829–2832, 1993
Allen DB, Rundle AC, Graves DA, Blethen SL: Risk of leukemia in children treated with human growth hormone: review and reanalysis. J Pediatr 131(1 Pt 2): S32–S36, 1997
Nishi Y, Tanaka T, Takano K, Fujieda K, Igarashi Y, Hanew K, Hirano T, Yokoya S, Tachibana K, Saito S, Watanabe S: Recent status in the occurrence of leukemia in growth hormone-treated patients in Japan. GH Treatment Study Committee of the Foundation for Growth Science, Japan. J Clin Endocrinol Metab 84: 1961–1965, 1999
Sklar CA, Mertens AC, Mitby P, Occhiogrosso G, Qin J, Heller G, Yasui Y, Robison LL: Risk of disease recurrence and second neoplasms in survivors of childhood cancer treated with growth hormone: a report from the Childhood Cancer Survivor Study. J Clin Endocrinol Metab 87: 3136–3141, 2002
Silfen ME, Garvin JH Jr, Hays AP, Starkman HS, Aranoff GS, Levine LS, Feldstein NA, Wong B, Oberfield SE: Primary central nervous system lymphoma in childhood presenting as progressive panhypopituitarism. J Pediatr Hematol Oncol 23: 130–133, 2001
Cairo MS, Gerrard M, Patte C: A new protocol for treatment of mature B-cell lymphoma/leukemia (BCLL): FAB LMB 96, a SFOP LMB96/CCG-5961/UKCCSG NHL 9600 international cooperative study. Med Pediatr Oncol (29): 357A, 1997
Cairo MS, Gerrard M, Sposto R, Auperin A, Pinkerton R, Michon J, Feldstein NA, Wong B, Oberfield SE: Results of a randomised FAB LMB96 international study in children and adolescents with advanced bone marrow and/or CNS B-NHL: patients with L3 leukemia/CNS-have an excellent prognosis. Proc. ASCO 22: 796, 2003
Frindik JP: Pituitary morphologic anomalies and magnetic resonance imaging in pediatric growth hormone deficiency. The Endocrinologist 11: 289–295, 2001
Mootha SL, Barkovich AJ, Grumbach MM, Edwards MS, Gitelman SE, Kaplan SL, Conte FA: Idiopathic hypothalamic diabetes insipidus, pituitary stalk thickening, and the occult intracranial germinoma in children and adolescents. J Clin Endocrinol Metab 82: 1362–1367, 1997
Leger J, Velasquez A, Garel C, Hassan M, Czernichow P: Thickened pituitary stalk on magnetic resonance imaging in children with central diabetes insipidus. J Clin Endocrinol Metab 84: 1954–1960, 1999
Jain R, Kumar R:Suprasellar tuberculoma presenting with diabetes insipidus and hypothyroidism – a case report. Neurol India 49: 314–316, 2001
Gutmann J, Kendall B: Unusual appearances of primary central nervous system non-Hodgkin's lymphoma. Clin Radiol 49: 696–702, 1994
Buchler T, Ferra C, Virgili N, Montanya E, Granena A: A relapsed non-Hodgkin lymphoma presenting as panhypopituitarism successfully treated by chemotherapy. J Neuro-Oncol 59: 35–38, 2002
Onda K, Wakabayashi K, Tanaka R, Takahashi H: Intracranial malignant lymphomas: clinicopathological study of 26 autopsy cases. Brain Tumor Pathol 16: 29–35, 1999
Valdez R, McKeever P, Finn WG, Gebarski S, Schnitzer B: Composite germ cell tumor and B-cell non-Hodgkin's lymphoma arising in the sella turcica. Hum Pathol 33: 1044–1047, 2002
Baleydier F, Galambrun C, Manel AM, Guibaud L, Nicolino M, Bertrand Y: Primary lymphoma of the pituitary stalk in an immunocompetent 9-year-old child. Med Pediatr Oncol 36: 392–395, 2001
Forbes GM, Cohen AK: Primary cerebral lymphoma: an association with craniopharyngioma or cadaveric growth hormone therapy? Med J Aust 157: 27–28, 1992
Hooghe-Peters EL, Hooghe R: Introduction: hormones, blood cells and immunity, with special reference to prolactin, growth hormone and insulin-like growth factor-I. Cell Mol Life Sci 54: 1057–1058, 1998
Leung DW, Spencer SA, Cachianes G, Hammonds RG, Collins C, Henzel WJ, Barnard R, Waters MJ, Wood WI: Growth hormone receptor and serum binding protein: purification, cloning and expression. Nature 330: 537–543, 1987
Varma S, Sabharwal P, Sheridan JF, Malarkey WB: Growth hormone secretion by human peripheral blood mononuclear cells detected by an enzyme-linked immunoplaque assay. J Clin Endocrinol Metab 76: 49–53, 1993
Wu H, Devi R, Malarkey WB: Localization of growth hormone messenger ribonucleic acid in the human immune system–a Clinical Research Center Study. J Clin Endocrinol Metab 81: 1278–1282, 1996
Lytras A, Quan N, Vrontakis ME, Shaw JE, Cattini PA, Friesen HG: Growth hormone expression in human Burkitt lymphoma serum-free Ramos cell line. Endocrinology 132: 620–628, 1993
Lincoln DT, Temmin L, al Jarallah MA, Mathew TC, Dashti H: Primary Ki-1 lymphoma of the skin: expression of growth hormone receptors. Nutrition 11(Suppl 5): 627–631, 1995
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Capra, M., Wherrett, D., Weitzman, S. et al. Pituitary Stalk Thickening and Primary Central Nervous System Lymphoma. J Neurooncol 67, 227–231 (2004). https://doi.org/10.1023/B:NEON.0000021863.06620.48
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DOI: https://doi.org/10.1023/B:NEON.0000021863.06620.48