Sellar and Parasellar Intravascular Lymphoma Mimicking Pituitary Apoplexy
BACKGROUNDIntravascular lymphoma (IVL) is a rare subtype of large-cell non-Hodgkin lymphoma, characterized by proliferation of lymphoma cells within the lumina of small vessels. There are no previously reported cases of IVL involving the pituitary gland presenting with neuro-ophthalmic findings. MET...
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| Veröffentlicht in: | Journal of neuro-ophthalmology 2012-03, Vol.32 (1), p.33-37 |
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| creator | Rizek, Philippe Seitelbach, Maayan Alturkustani, Murad Leung, Andrew Fraser, J Alexander |
| description | BACKGROUNDIntravascular lymphoma (IVL) is a rare subtype of large-cell non-Hodgkin lymphoma, characterized by proliferation of lymphoma cells within the lumina of small vessels. There are no previously reported cases of IVL involving the pituitary gland presenting with neuro-ophthalmic findings.
METHODSA 68-year-old female presented with headache, right third nerve palsy, and Horner syndrome. MRI showed a 1.4-cm sellar mass consistent with a pituitary macroadenoma. Two weeks later, despite treatment with dexamethasone, the patient developed complete bilateral ophthalmoplegia and ptosis. Repeat MRI showed invasion of the clivus and cavernous sinuses, and a transsphenoidal pituitary biopsy was undertaken.
RESULTSThe preliminary histopathology was consistent with bland pituitary apoplexy, but subsequent examination of an incidentally biopsied nasal polyp revealed endovascular malignant lymphoid cells that, on further scrutiny, were also present in the pituitary tissue. The diagnosis of IVL was confirmed, and the patient had an excellent clinical and radiological response to cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab (CHOP-R) chemotherapy.
CONCLUSIONIVL may involve the pituitary gland, causing sellar mass effect, cavernous sinus infiltration, and pituitary ischemia, mimicking pituitary apoplexy with neuro-ophthalmic features. It can be effectively treated with CHOP-R chemotherapy. |
| doi_str_mv | 10.1097/WNO.0b013e31823f457e |
| format | Article |
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METHODSA 68-year-old female presented with headache, right third nerve palsy, and Horner syndrome. MRI showed a 1.4-cm sellar mass consistent with a pituitary macroadenoma. Two weeks later, despite treatment with dexamethasone, the patient developed complete bilateral ophthalmoplegia and ptosis. Repeat MRI showed invasion of the clivus and cavernous sinuses, and a transsphenoidal pituitary biopsy was undertaken.
RESULTSThe preliminary histopathology was consistent with bland pituitary apoplexy, but subsequent examination of an incidentally biopsied nasal polyp revealed endovascular malignant lymphoid cells that, on further scrutiny, were also present in the pituitary tissue. The diagnosis of IVL was confirmed, and the patient had an excellent clinical and radiological response to cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab (CHOP-R) chemotherapy.
CONCLUSIONIVL may involve the pituitary gland, causing sellar mass effect, cavernous sinus infiltration, and pituitary ischemia, mimicking pituitary apoplexy with neuro-ophthalmic features. It can be effectively treated with CHOP-R chemotherapy.</description><identifier>ISSN: 1070-8022</identifier><identifier>EISSN: 1536-5166</identifier><identifier>DOI: 10.1097/WNO.0b013e31823f457e</identifier><identifier>PMID: 22173269</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins, Inc</publisher><subject>Aged ; Biopsy ; Cardiovascular system ; Cavernous Sinus Thrombosis - etiology ; Cavernous Sinus Thrombosis - pathology ; Cavernous Sinus Thrombosis - physiopathology ; Cell proliferation ; Chemotherapy ; Dexamethasone ; Diagnosis, Differential ; Doxorubicin ; Female ; Headache ; Hemangiopericytoma - drug therapy ; Hemangiopericytoma - pathology ; Hemangiopericytoma - physiopathology ; Humans ; Innervation ; Ischemia ; Lymphoid cells ; Lymphoma ; Lymphoma, Large B-Cell, Diffuse - drug therapy ; Lymphoma, Large B-Cell, Diffuse - pathology ; Lymphoma, Large B-Cell, Diffuse - physiopathology ; Magnetic resonance imaging ; Mimicry ; Ophthalmoplegia ; Ophthalmoplegia - etiology ; Ophthalmoplegia - pathology ; Ophthalmoplegia - physiopathology ; Pituitary ; Pituitary Neoplasms - secondary ; rituximab ; Sinus ; Skull ; Vascular Neoplasms - drug therapy ; Vascular Neoplasms - pathology ; Vascular Neoplasms - physiopathology ; Vincristine</subject><ispartof>Journal of neuro-ophthalmology, 2012-03, Vol.32 (1), p.33-37</ispartof><rights>2012 Lippincott Williams & Wilkins, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4308-d6b35332c4c9db23f20f7a0fdca54a9ab3f7d15ea99cf0839f8c2e6c84bc2cef3</citedby><cites>FETCH-LOGICAL-c4308-d6b35332c4c9db23f20f7a0fdca54a9ab3f7d15ea99cf0839f8c2e6c84bc2cef3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&AN=00041327-201203000-00008$$EHTML$$P50$$Gwolterskluwer$$H</linktohtml><link.rule.ids>314,776,780,4595,27901,27902,65434</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22173269$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rizek, Philippe</creatorcontrib><creatorcontrib>Seitelbach, Maayan</creatorcontrib><creatorcontrib>Alturkustani, Murad</creatorcontrib><creatorcontrib>Leung, Andrew</creatorcontrib><creatorcontrib>Fraser, J Alexander</creatorcontrib><title>Sellar and Parasellar Intravascular Lymphoma Mimicking Pituitary Apoplexy</title><title>Journal of neuro-ophthalmology</title><addtitle>J Neuroophthalmol</addtitle><description>BACKGROUNDIntravascular lymphoma (IVL) is a rare subtype of large-cell non-Hodgkin lymphoma, characterized by proliferation of lymphoma cells within the lumina of small vessels. There are no previously reported cases of IVL involving the pituitary gland presenting with neuro-ophthalmic findings.
METHODSA 68-year-old female presented with headache, right third nerve palsy, and Horner syndrome. MRI showed a 1.4-cm sellar mass consistent with a pituitary macroadenoma. Two weeks later, despite treatment with dexamethasone, the patient developed complete bilateral ophthalmoplegia and ptosis. Repeat MRI showed invasion of the clivus and cavernous sinuses, and a transsphenoidal pituitary biopsy was undertaken.
RESULTSThe preliminary histopathology was consistent with bland pituitary apoplexy, but subsequent examination of an incidentally biopsied nasal polyp revealed endovascular malignant lymphoid cells that, on further scrutiny, were also present in the pituitary tissue. The diagnosis of IVL was confirmed, and the patient had an excellent clinical and radiological response to cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab (CHOP-R) chemotherapy.
CONCLUSIONIVL may involve the pituitary gland, causing sellar mass effect, cavernous sinus infiltration, and pituitary ischemia, mimicking pituitary apoplexy with neuro-ophthalmic features. It can be effectively treated with CHOP-R chemotherapy.</description><subject>Aged</subject><subject>Biopsy</subject><subject>Cardiovascular system</subject><subject>Cavernous Sinus Thrombosis - etiology</subject><subject>Cavernous Sinus Thrombosis - pathology</subject><subject>Cavernous Sinus Thrombosis - physiopathology</subject><subject>Cell proliferation</subject><subject>Chemotherapy</subject><subject>Dexamethasone</subject><subject>Diagnosis, Differential</subject><subject>Doxorubicin</subject><subject>Female</subject><subject>Headache</subject><subject>Hemangiopericytoma - drug therapy</subject><subject>Hemangiopericytoma - pathology</subject><subject>Hemangiopericytoma - physiopathology</subject><subject>Humans</subject><subject>Innervation</subject><subject>Ischemia</subject><subject>Lymphoid cells</subject><subject>Lymphoma</subject><subject>Lymphoma, Large B-Cell, Diffuse - drug therapy</subject><subject>Lymphoma, Large B-Cell, Diffuse - pathology</subject><subject>Lymphoma, Large B-Cell, Diffuse - physiopathology</subject><subject>Magnetic resonance imaging</subject><subject>Mimicry</subject><subject>Ophthalmoplegia</subject><subject>Ophthalmoplegia - etiology</subject><subject>Ophthalmoplegia - pathology</subject><subject>Ophthalmoplegia - physiopathology</subject><subject>Pituitary</subject><subject>Pituitary Neoplasms - secondary</subject><subject>rituximab</subject><subject>Sinus</subject><subject>Skull</subject><subject>Vascular Neoplasms - drug therapy</subject><subject>Vascular Neoplasms - pathology</subject><subject>Vascular Neoplasms - physiopathology</subject><subject>Vincristine</subject><issn>1070-8022</issn><issn>1536-5166</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1PwzAMhiMEYjD4Bwj1BpcOJ2mb5jhNfEwabBIgjlGaJqysXUvSMvbvybQBEgcOVmzpseP3NUJnGAYYOLt6eZgOIANMNcUpoSaKmd5DRzimSRjjJNn3OTAIUyCkh46dewMACoQfoh4hmFGS8CM0ftRlKW0gl3kwk1a6bTletlZ-SKe6TTVZV828rmRwX1SFWhTL12BWtF3RSrsOhk3dlPpzfYIOjCydPt29ffR8c_00ugsn09vxaDgJVUQhDfMkozGlREWK55nfm4BhEkyuZBxJLjNqWI5jLTlXBlLKTaqITlQaZYoobWgfXWznNrZ-77RrRVU4tVl7qevOCe61EcxT7snLf0kMCcc8ZsA8Gm1RZWvnrDaisUXl5XlIbOwW3m7x127fdr77ocsqnf80ffv7O3dVl622blF2K23FXMuynQt_kAhTwkICmPjbAIQ-vOgv3euM1A</recordid><startdate>201203</startdate><enddate>201203</enddate><creator>Rizek, Philippe</creator><creator>Seitelbach, Maayan</creator><creator>Alturkustani, Murad</creator><creator>Leung, Andrew</creator><creator>Fraser, J Alexander</creator><general>Lippincott Williams & Wilkins, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7X8</scope></search><sort><creationdate>201203</creationdate><title>Sellar and Parasellar Intravascular Lymphoma Mimicking Pituitary Apoplexy</title><author>Rizek, Philippe ; Seitelbach, Maayan ; Alturkustani, Murad ; Leung, Andrew ; Fraser, J Alexander</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4308-d6b35332c4c9db23f20f7a0fdca54a9ab3f7d15ea99cf0839f8c2e6c84bc2cef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Biopsy</topic><topic>Cardiovascular system</topic><topic>Cavernous Sinus Thrombosis - etiology</topic><topic>Cavernous Sinus Thrombosis - pathology</topic><topic>Cavernous Sinus Thrombosis - physiopathology</topic><topic>Cell proliferation</topic><topic>Chemotherapy</topic><topic>Dexamethasone</topic><topic>Diagnosis, Differential</topic><topic>Doxorubicin</topic><topic>Female</topic><topic>Headache</topic><topic>Hemangiopericytoma - drug therapy</topic><topic>Hemangiopericytoma - pathology</topic><topic>Hemangiopericytoma - physiopathology</topic><topic>Humans</topic><topic>Innervation</topic><topic>Ischemia</topic><topic>Lymphoid cells</topic><topic>Lymphoma</topic><topic>Lymphoma, Large B-Cell, Diffuse - drug therapy</topic><topic>Lymphoma, Large B-Cell, Diffuse - pathology</topic><topic>Lymphoma, Large B-Cell, Diffuse - physiopathology</topic><topic>Magnetic resonance imaging</topic><topic>Mimicry</topic><topic>Ophthalmoplegia</topic><topic>Ophthalmoplegia - etiology</topic><topic>Ophthalmoplegia - pathology</topic><topic>Ophthalmoplegia - physiopathology</topic><topic>Pituitary</topic><topic>Pituitary Neoplasms - secondary</topic><topic>rituximab</topic><topic>Sinus</topic><topic>Skull</topic><topic>Vascular Neoplasms - drug therapy</topic><topic>Vascular Neoplasms - pathology</topic><topic>Vascular Neoplasms - physiopathology</topic><topic>Vincristine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rizek, Philippe</creatorcontrib><creatorcontrib>Seitelbach, Maayan</creatorcontrib><creatorcontrib>Alturkustani, Murad</creatorcontrib><creatorcontrib>Leung, Andrew</creatorcontrib><creatorcontrib>Fraser, J Alexander</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neuro-ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rizek, Philippe</au><au>Seitelbach, Maayan</au><au>Alturkustani, Murad</au><au>Leung, Andrew</au><au>Fraser, J Alexander</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sellar and Parasellar Intravascular Lymphoma Mimicking Pituitary Apoplexy</atitle><jtitle>Journal of neuro-ophthalmology</jtitle><addtitle>J Neuroophthalmol</addtitle><date>2012-03</date><risdate>2012</risdate><volume>32</volume><issue>1</issue><spage>33</spage><epage>37</epage><pages>33-37</pages><issn>1070-8022</issn><eissn>1536-5166</eissn><abstract>BACKGROUNDIntravascular lymphoma (IVL) is a rare subtype of large-cell non-Hodgkin lymphoma, characterized by proliferation of lymphoma cells within the lumina of small vessels. There are no previously reported cases of IVL involving the pituitary gland presenting with neuro-ophthalmic findings.
METHODSA 68-year-old female presented with headache, right third nerve palsy, and Horner syndrome. MRI showed a 1.4-cm sellar mass consistent with a pituitary macroadenoma. Two weeks later, despite treatment with dexamethasone, the patient developed complete bilateral ophthalmoplegia and ptosis. Repeat MRI showed invasion of the clivus and cavernous sinuses, and a transsphenoidal pituitary biopsy was undertaken.
RESULTSThe preliminary histopathology was consistent with bland pituitary apoplexy, but subsequent examination of an incidentally biopsied nasal polyp revealed endovascular malignant lymphoid cells that, on further scrutiny, were also present in the pituitary tissue. The diagnosis of IVL was confirmed, and the patient had an excellent clinical and radiological response to cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab (CHOP-R) chemotherapy.
CONCLUSIONIVL may involve the pituitary gland, causing sellar mass effect, cavernous sinus infiltration, and pituitary ischemia, mimicking pituitary apoplexy with neuro-ophthalmic features. It can be effectively treated with CHOP-R chemotherapy.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>22173269</pmid><doi>10.1097/WNO.0b013e31823f457e</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Biopsy Cardiovascular system Cavernous Sinus Thrombosis - etiology Cavernous Sinus Thrombosis - pathology Cavernous Sinus Thrombosis - physiopathology Cell proliferation Chemotherapy Dexamethasone Diagnosis, Differential Doxorubicin Female Headache Hemangiopericytoma - drug therapy Hemangiopericytoma - pathology Hemangiopericytoma - physiopathology Humans Innervation Ischemia Lymphoid cells Lymphoma Lymphoma, Large B-Cell, Diffuse - drug therapy Lymphoma, Large B-Cell, Diffuse - pathology Lymphoma, Large B-Cell, Diffuse - physiopathology Magnetic resonance imaging Mimicry Ophthalmoplegia Ophthalmoplegia - etiology Ophthalmoplegia - pathology Ophthalmoplegia - physiopathology Pituitary Pituitary Neoplasms - secondary rituximab Sinus Skull Vascular Neoplasms - drug therapy Vascular Neoplasms - pathology Vascular Neoplasms - physiopathology Vincristine |
| title | Sellar and Parasellar Intravascular Lymphoma Mimicking Pituitary Apoplexy |
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