Pituitary Infiltration by Lymphoma

Abstract

Lymphoma infiltration to pituitary is rare. It represents <0.5% of all reported pituitary metastasis. Here we present a case series of three patients with pituitary metastases from a systemic lymphoma. Also, we performed a literature review of the cases reported. We identified additional 31 cases where non-Hodgkin's lymphoma (NHL) was the most common (n = 28, 90%), with large B-cell NHL the most frequent histological subtype (n = 14, 45%). Central hypothyroidism (n = 21, 67%) was the most frequent pituitary deficiency followed by adrenal insufficiency (n = 19, 61%), and diabetes insipidus (n = 18, 58%). Full endocrine recovery was found in only 12% (n = 4) of patients after treatment, and the MRI showed tumor regression in 22% of them. In our series, two patients were diagnosed with diffuse large B-cell lymphoma, and one had mixed cellularity of classical Hodgkin lymphoma. The mean age was 54 ± 6.92 years. Hypopituitarism and diabetes insipidus were present in all of them, with 100% of mortality because of the advanced systemic disease.

Panhypopituitarism in a Patient with Burkitt Lymphoma: A Diagnostic and Therapeutic Challenge

“… 7 Pituitary infiltration by systemic lymphoma is an exceedingly rare phenomenon, accounting for only 0.5% of cases. 3 This is in contrast to cases secondary to solid tumors, which account for 60% of PM. 4 The most frequent primary tumor sites for these cases include the lung (28%), breast (19%), kidney (15%), thyroid (8%), gastrointestinal tract (6%) and prostate (6%).…”

“… 7 Most patients exhibit pituitary dysfunction before systemic lymphoma becomes evident, however, in other cases, lymphoma can precede pituitary dysfunction or develop during the course of the disease, as was the case with our patient, whose pituitary symptoms were documented during hospitalization. 3 , 5 , 6 …”

“…Diagnosis is mostly based on the correlation of clinical and imaging characteristics, as in the case we have presented, and therapeutic response can serve as confirmation, since the volume of PM will rapidly decrease after systemic chemotherapy, which does not occur in pituitary adenomas, apoplexy or hypophysitis. 3 , 16 …”

“… 5 PM can affect both the adenohypophysis, which can primarily trigger hypothyroidism and central adrenal insufficiency, as well as the neurohypophysis, which can lead to arginine vasopressin (AVP) deficiency. 3 Panhypopituitarism is reported to be even rarer. 6 …”

“…1 Pituitary metastases (PM) are exceedingly rare, and it is even more unusual for them to be secondary to haematologic malignancies, with systemic lymphoma being the primary cause in these instances, accounting for 0.5% of all PM cases. 3,4 From a histological perspective, non-Hodgkin B-cell lymphomas are the most common lymphomas to cause PM. To date, the medical literature has documented 34 cases of pituitary infiltration by lymphomas.…”