Meira Goncalves Joao, Polónia Patricia, Pereira Josué, Silva Pedro Alberto
Neurosurgery Department, Centro Hospitalar Universitário de São João, Porto, PRT.
Faculty of Medicine, University of Porto, Porto, PRT.
Cureus. 2023 Dec 21;15(12):e50912. doi: 10.7759/cureus.50912. eCollection 2023 Dec.
Pituitary lymphoma is one of the rare variants of primary central nervous system lymphoma (PCNSL), mostly arising due to the metastatic spread of systemic lymphoma. We report the case of a 69-year-old woman who initially presented to her family physician with a headache but without any other symptoms. The MRI scan revealed a sellar mass consistent with a pituitary macroadenoma. When the patient was referred to our hospital, two weeks later, the symptoms had progressed, comprising complete right-sided ophthalmoplegia and ptosis, with left-sided amaurosis. A repeat MRI revealed an increased size of the sellar mass, consistent with pituitary apoplexy. A right pterional craniotomy with partial resection of the mass was performed and an intraoperative frozen section biopsy was carried out. The final pathology revealed diffuse large B-cell lymphoma. A systemic follow-up including a whole-body CT, bone marrow aspiration, and cerebrospinal fluid studies ruled out any systemic manifestation, and the patient was HIV-negative. The patient underwent treatment with methotrexate, cytarabine, thiotepa, and rituximab for PCNSL. Although rare, PCNSL can mimic pituitary apoplexy, which needs to be considered if conservative therapy or surgery is to be offered to a patient with a radiological and clinical diagnosis of pituitary apoplexy.
垂体淋巴瘤是原发性中枢神经系统淋巴瘤（PCNSL）的罕见变异类型之一，大多由系统性淋巴瘤转移扩散所致。我们报告一例69岁女性病例，该患者最初因头痛就诊于家庭医生处，无其他任何症状。MRI扫描显示鞍区肿块，符合垂体大腺瘤表现。两周后患者转诊至我院时，症状已进展，包括右侧完全性眼肌麻痹和上睑下垂，伴有左侧黑矇。复查MRI显示鞍区肿块增大，符合垂体卒中表现。遂行右翼点开颅术并部分切除肿块，术中进行了冰冻切片活检。最终病理结果显示为弥漫性大B细胞淋巴瘤。包括全身CT、骨髓穿刺和脑脊液检查在内的全身检查排除了任何系统性表现，且患者HIV检测为阴性。该患者接受了甲氨蝶呤、阿糖胞苷、噻替派和利妥昔单抗治疗PCNSL。尽管罕见，但PCNSL可模拟垂体卒中，对于影像学和临床诊断为垂体卒中的患者若考虑给予保守治疗或手术时，需要考虑到这一点。
