Wednesday, November 28, 2018

A middle-aged patient with panhypopituitarism

The clinicoradiological suspicion in this case of a middle-aged patient with panhypopituitarism was hypophysitis.

T1 sagittal post-contrast
Transphenoidal hypohysectomy yielded the following specimen:

Two populations of cells predominate: small monomorphic cells and larger pleomorphic cells
Immunohistochemistry identified the larger pleomorphic cells as representing a large B-cell lymphoma, while the small cells were intermixed non-neoplastic T-cells.

This ACTH immunostain demonstrates the progressive obliteration of the pituitary gland by the invading lymphoma

Diffuse large B-cell lymphoma presenting as a pituitary mass is rare. A few case reports exist in the literature.

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