PDF(Pubmed)
Abstract：
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.
摘要：
垂体淋巴瘤是原发性中枢神经系统淋巴瘤（PCNSL）的罕见变种之一，主要是由于全身性淋巴瘤的转移扩散。我们报告了一名69岁的妇女，该妇女最初因头痛而向家庭医生就诊，但没有任何其他症状。MRI扫描显示鞍状肿块与垂体大腺瘤一致。当病人被转诊到我们医院时，两周后,症状有所进展,包括完全右侧眼肌麻痹和上睑下垂，左侧黑蒙.重复MRI显示鞍块的大小增加，与垂体卒中一致.进行了右侧翼点开颅手术，部分切除了肿块，并进行了术中冰冻切片活检。最终病理提示弥漫性大B细胞淋巴瘤。包括全身CT在内的全身随访，骨髓穿刺,脑脊液研究排除了任何系统性表现，病人是HIV阴性.患者接受了甲氨蝶呤治疗，阿糖胞苷,Thiotepa,利妥昔单抗用于PCNSL。虽然罕见，PCNSL可以模拟垂体卒中，如果要向放射学和临床诊断为垂体中风的患者提供保守治疗或手术，则需要考虑。
