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Case Reports
. 2017 Jan 1;80(1):E170-E175.
doi: 10.1093/neuros/nyw003.

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

Vin Shen Ban  1 , Bedansh Roy Chaudhary  1 , Kieren Allinson  2 , Thomas Santarius  1 , Ramez Wadie Kirollos  1
Affiliations
Case Reports

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

Vin Shen Ban et al. Neurosurgery. .

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.

Keywords: Apoplexy; Diffuse large B-cell lymphoma; Follicle-stimulating hormone; Gonadotroph; Lymphoma; Macroadenoma; Pituitary.

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Figures

FIGURE 1.
FIGURE 1.
Magnetic resonance imaging scans of the sellar region at presentation. A, Sagittal T1 with contrast. B, Coronal T1 with contrast.
FIGURE 2.
FIGURE 2.
Histopathology and immunohistochemistry of the surgically resected pituitary tumor. Figures 2A, 2C, and 2E were from the same field. A, H&E × 400 – high-grade non-Hodgkin's lymphoma. B, H&E × 50 – pituitary adenoma undergoing acute necrosis (left-hand side of field). C, CD20 × 400 – strong and diffuse positivity for CD20. D, FSH × 50 – strong positivity in the residual viable adenoma. E, FSH × 400 – focal but strong FSH immunoreactivity by the lymphoma cells. F, FSH × 400 – strong positivity in the residual viable adenoma demonstrating a different cell morphology compared to the lymphoma cells. Abbreviations: H&E – hematoxylin & eosin; FSH – follicle-stimulating hormone.
See this image and copyright information in PMC

References

    1. Dolecek TA, Propp JM, Stroup NE, Kruchko C. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2005-2009. Neuro Oncol. 2012;14(suppl 5):v1-49. - PMC - PubMed
    1. Ganesan D, Dean AF, Antoun N, Kirollos RW. A second biopsy?–Tandem lesion. Acta Neurochir (Wien). 2008;150(5):501-503. - PubMed
    1. Kuhn D, Buchfelder M, Brabletz T, Paulus W. Intrasellar malignant lymphoma developing within pituitary adenoma. Acta Neuropathol. 1999;97(3):311-316. - PubMed
    1. Au WY, Kwong YL, Shek TW, Leung G, Ooi C. Diffuse large-cell B-cell lymphoma in a pituitary adenoma: an unusual cause of pituitary apoplexy. Am J Hematol. 2000;63(4):231-232. - PubMed
    1. Romeike BF, Joellenbeck B, Stein H et al. Precursor T-lymphoblastic lymphoma within a recurrent pituitary adenoma. Acta Neurochir (Wien). 2008;150(8):833-836. - PubMed

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