Metastatic Mantle Cell Lymphoma to the Pituitary Gland: Case Report and Literature Review

Abstract

We present an unusual case of a metastatic mantle cell lymphoma (MCL) to the pituitary gland. The patient had a known history of MCL for which she previously received chemotherapy. She presented with new-onset diplopia and confusion, and reported a history of progressive vision blurriness associated with headache, nausea, and vomiting. MRI of the brain showed an enhancing lesion within the sella turcica involving the cavernous sinuses bilaterally, extending into Meckel's cave on the left, and abutting the optic nerves bilaterally. Following surgical excision, histopathology revealed the tumor to be a MCL. Metastatic pituitary tumors are rare and have been estimated to make up 1% of tumors discovered in the sellar region. The two most common secondary metastatic lesions to the sella are breast and lung carcinoma followed by prostate, renal cell, and gastrointestinal carcinoma. Metastatic lymphoma to the pituitary gland is especially rare and is estimated to constitute 0.5% of all metastatic tumors to the sella turcica. To our knowledge, this is the first reported case of MCL metastasizing to the pituitary gland.

Pituitary Infiltration by Lymphoma

“…This was attributed to the posterior lobe circulation coming directly from the hypophyseal arteries, while the anterior lobe is nourished through the portal system [ 36 ]. However, in our case series and after literature review, we noticed that lymphoma may infiltrate more commonly the anterior (52%, n = 16) [ 7 , 9 , 12 , 13 , 16-20 , 22 , 23 , 25 , 26 , 30 , 32 , 33 ] rather than the posterior (26%, n = 8) [ 4 , 8 , 10 , 11 , 14 , 24 ] pituitary lobes. Interestingly, both lobes were affected in 22% of cases (n = 7) [ 6 , 18 , 20 , 27-29 , 31 ].…”

“…Pituitary involvement was the initial presentation of a systemic lymphoma in 58% of patients (n = 18) [ 4 , 8 , 13 , 16 , 18 , 20-23 , 25 , 27-31 , 33 ]. Also, a similar proportion of cases was identified throughout the disease activity (22%, n = 7) [ 9-11 , 14 , 15 , 19 , 24 ] or were a consequence of lymphoma recurrence (19%, n = 6) [ 6 , 7 , 12 , 17 , 26 , 32 ]. Additionally, cases 1 and 3 presented here started with DI, and case 2 after recurrence of systemic disease.…”

“…Also, since survival is usually short and clinical conditions of the patient may be poor, transsphenoidal surgery may not be mandatory. Of the 31 reported cases, only one-third (29%, n = 9) reported histopathological confirmation of pituitary lymphoma infiltration [ 6 , 7 , 12 , 16 , 19 , 20 , 24 , 26 , 27 ]. The same proportion was seen in our case series, and only in case 3 was pituitary biopsy considered necessary.…”

Non-Hodgkin B-cell Lymphoma Presenting as a Pituitary Mass

“…From a pathogenetic model of involvement, pituitary gland could be infiltrated from malignant cells in primary CNS lymphoma; but metastases are as well reported in other forms of lymphoma, and their appearance is more dramatic, as a rule [2], [3]. The authors concur with the fact that posterior pituitary is more susceptible to metastases [4], [5].…”

Pituitary metastasis in breast cancer: case report and literature review

“…A total of 16 patients with pituitary metastasis were reported in the previous 10 years. (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) The collected information and primary lesion data are presented in Table I. The average age of all patients was 61.5 years, and the number of females was twice as high as that of males (11:5).…”