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Non-Hodgkin lymphoma causing hypopituitarism - can imaging help diagnosis and management?
Khan, Uzma Borg, Anton Beltechi, Radu Mehta, Hiten Robbins, Timothy Randeva, Harpal Machenahalli, Pratibha
Khan, Uzma
Borg, Anton
Beltechi, Radu
Mehta, Hiten
Robbins, Timothy
Randeva, Harpal
Machenahalli, Pratibha
Abstract
Non-Hodgkin lymphomas of the hypothalamus and pituitary are rare. They usually remain clinically silent until onset of compressive features affecting surrounding structures. When symptomatic, patients most commonly present with diabetes insipidus, headaches, ophthalmoplegia and/or bilateral hemianopia. We report a case of a 67-year-old Caucasian female with a history of B-cell lymphoma in complete remission. She presented with left oculomotor nerve palsy and was subsequently found to have a sellar/suprasellar mass lesion on MRI. Alongside hypocortisolism and hypogonadotropic hypogonadism, she developed transient diabetes insipidus during her illness. Her clinical course was characterized by rapid intracranial progression of the sellar mass. MR spectroscopy suggested a diagnosis of lymphoma. Diagnostic biopsy confirmed high-grade diffuse large B-cell CNS lymphoma; this changed the definitive management from surgical excision to chemotherapy. Despite treatment, she succumbed to her illness within 7 months of initial presentation. This case highlights the aggressive nature of CNS lymphomas and the need for a high index of suspicion in an unusual presentation of sellar/suprasellar mass lesions.
Learning points: Novel imaging techniques such as MR spectroscopy might help to differentiate some brain tumours from pituitary macroadenomas, but these are not diagnostic.Tissue diagnosis with biopsy and histopathology is the gold standard for deciding management of pituitary fossa mass lesions with atypical presentation.
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Date
2021-12
Type
Article
Subject
Oncology. Pathology., Radiology
Citation
Khan U, Borg A, Beltechi R, Mehta H, Robbins T, Randeva H, Machenahalli P. Non-Hodgkin Lymphoma Causing Hypopituitarism Can Imaging Help Diagnosis and Management? Eur J Case Rep Intern Med. 2021 Dec 23;8(12):002980. doi: 10.12890/2021_002980.
Journal / Source Title
European Journal of Case Reports in Internal Medicine
DOI
10.12890/2021_002980
PMID
35059332
Publisher
SMC media
Publisher’s URL
http://www.ncbi.nlm.nih.gov/pmc/articles/pmc8765684/
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