Article
Lymphoma manifestations in the sellar region – a clinical diagnostic challenge
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Authors
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Agnieszka Grzywotz
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Sophia Göricke
- Universitätsklinikum Essen, Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Essen, Deutschland
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Andreas Junker
- Universitätsklinikum Essen, Institut für Neuropathologie, Essen, Deutschland
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Nicole Unger
- Universitätsklinikum Essen, Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Essen, Deutschland
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Ulrich Sure
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Oliver Müller
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Ilonka Kreitschmann-Andermahr
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Malignant tumors in the sellar region are rare occurrences. If present, the most common neoplastic sources to the sella are metastases stemming from breast, lung and renal cell cancer. Lymphoma manifestations in the sella belong to the most exceptional malignant lesions. We report four patients in whom a sellar or hypothalamic mass was the first disease manifestation and a further one with a history of lymph node cancer who was in full remission when diagnosed with a pituitary lesion.
Methods: Retrospective evaluation of chart records, clinical, imaging and histological data.
Results: The patient group comprises 1 male and 4 females with a mean age of 74 years. The most common presenting signs and symptoms were anterior pituitary insufficiency (n=4) with Addisonian crisis in two of them, fatigue (n=3), disturbed consciousness (n=3), followed by ophthalmoplegia (n=2) and headache (n=2). Diabetes insipidus was present in only one patient. In all patients the pituitary process was not limited to the pituitary alone. Imaging features of sellar lymphomas in magnetic resonance imaging (MRI) included suprasellar (n=4) and parasellar (n=3) extension, development of the process into the sphenoid sinus (n=1), thickening of the pituitary stalk (n=4), loss of the bright spot (n=4) and contrast enhancement of the cavernous and sphenoid sinus (n=5). Diagnosis of lymphoma was established by transnasal-transsphenoidal biopsy in all cases. Three patients died within 8 months of diagnosis of lymphoma.
Conclusion: Acute onset hypopituitarism, ophthalmoplegia and diabetes insipidus constitute clinical features of infiltrative malignant or inflammatory sellar lesions. Thickening of pituitary stalk, contrast enhancement of the parasellar structures in MRI in processes not limited to the sella alone in combination the with above-mentioned clinical signs should make the neurosurgeon consider biopsy to reveal the diagnosis, especially against the background of the potentially rapid clinical course of lymphomatous lesions.
