Concomitant Primary CNS Lymphoma and FSH-Pituitary Adenoma Arising Within the Sella. Entirely Coincidental?

Abstract

BACKGROUND AND IMPORTANCE: Collision tumors are the simultaneous occurrence of more than one type of neoplasm within an anatomic space. In the pituitary sella, collision tumors are exceedingly rare, and not much is known about their etiology and prognosis. CLINICAL PRESENTATION: A 74-year-old man presented with a concomitant primary pituitary lymphoma (diffuse large B-cell non-Hodgkin's lymphoma; DLBCL) and follicle-stimulating hormone (FSH)-adenoma diagnosed histologically after clinical features of apoplexy prompted urgent surgical decompression and resection. Strong immunoreactivity for FSH by the lymphoma was evident. Full-body workup demonstrated no other source for the lymphoma. He subsequently underwent 4 cycles of chemotherapy and has been in remission for over 32 months. His ophthalmoplegia at presentation persisted with no further deficits. CONCLUSIONS: Four cases of collision tumors of primary pituitary lymphoma and adenoma have previously been reported. This case represents the first combination of an FSH-adenoma and a DLBCL in the literature. Prompt involvement of the hematology-oncology team contributed to the good outcome seen in this case. The putative role played by pituitary hormones in tumorigenesis is reviewed in this case report. The association is either a chance occurrence or due to the induction of lymphoma cell proliferation by the binding of FSH produced by the adenoma to the FSH receptors on the lymphoma cells.

Primary Pituitary Lymphoma As Rare Cause Of A Pituitary Mass And Hypopituitarism In Adulthood

“…Notable, 5 concomitant pituitary adenomas and 2 cases of pituitary cell hyperplasia were diagnosed (19,20,31,37,43,45,46). This association could be explained by the stimulating effect of pituitary hormones on lymphoma cells that is known to express endocrine hormones receptors (57,58), but this association is speculative and remain to be elucidated so far.…”

Pituitary Gland as a Rare Primary Localization of Lymphoma

“…Another theory regarding the PPL origin is that it may develop as a secondary manifestation of lymphocytic hypophysitis or pituitary adenoma (10). Although few case reports support the above-mentioned theories (9,11), no signs of lymphocytic hypophysitis or adenoma were detected in the histopathological examination in the present case.…”

Cushing’s disease due to a pituitary adenoma as a component of collision tumor: A case report and review of the literature

“…d-f After transsphenoidal surgery, T1-weighted with contrast sagittal, T1-weighted without contrast coronal, T2-weighted without contrast coronal views, respectively, tumor resection collision sellar lesion can only be determined by histological examination; therefore, preoperative diagnosis is quite difficult. Most case reports include a pituitary adenoma coexisting with either neoplastic, adenomatous, congenital, vascular, or inflammatory sellar lesions such as: another adenoma [5,6,12,13]; craniopharyngioma [14][15][16][17][18]; schwannoma [5]; hypophysitis [19,20]; arachnoid, colloid, and epidermoid cysts [21][22][23]; gangliocytoma [5,[24][25][26]; Rathke's cleft cyst [5,14,27]; neurosarcoidosis [5,28]; plasmacytoma [29]; chondroma [30]; lymphoma [31]; lung cancer metastasis [32]; and meningioma [6][7][8].…”

“…One suggested mechanism is that GH secretion induces meningioma formation in patients with GHsecreting pituitary adenoma [41,42]. Other possible etiologies beyond stimulation by GH can be paracrine growth effects of other pituitary hormones, due to hormone receptor immunoreactivity found within the meningiomatous component of the collision tumor or the existence of a common progenitor cell of origin as described in other types of collision tumors [31,43].…”