Sellar and Parasellar Intravascular Lymphoma Mimicking Pituitary Apoplexy
Sellar and Parasellar Intravascular Lymphoma Mimicking Pituitary Apoplexy
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类似垂体卒中的鞍区和鞍区血管内淋巴瘤
DOI：
10.1097/wno.0b013e31823f457e
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发表时间：
2012
影响因子：
2.9
通讯作者：
J. A. Fraser
中科院分区：
文献类型：
--
作者：
P. Rizek;Maayan Seitelbach;M. Alturkustani;A. Leung;J. A. Fraser
血管内淋巴瘤（IVL）是一种罕见的大细胞非霍奇金淋巴瘤亚型，以小血管腔内淋巴瘤细胞增殖为特征。没有先前报道的病例IVL累及脑垂体呈现神经眼科的发现。方法68岁女性，以头痛、右三神经麻痹、霍纳综合征为主要临床表现。MRI显示一1.4 cm鞍区肿块，符合垂体大腺瘤。两周后，尽管使用地塞米松治疗，患者仍出现完全性双侧眼麻痹和上睑下垂。复查MRI显示斜坡和海绵窦侵犯，经蝶窦垂体活检。结果初步组织病理学与轻度垂体卒中一致，但随后的鼻息肉活检检查显示血管内恶性淋巴样细胞，进一步检查，垂体组织中也存在。确诊为IVL，患者对环磷酰胺、阿霉素、长春新碱、强的松龙、利妥昔单抗（CHOP-R）化疗均有良好的临床和放射学反应。结论IVL可能累及垂体，引起鞍块效应、海绵窦浸润及垂体缺血，具有垂体卒中的神经眼特征。CHOP-R化疗可有效治疗。
Background Intravascular 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. Methods A 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. Results The 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. Conclusion IVL 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.
影响因子：
45.3
作者：
Shimada, Kazuyuki;Matsue, Kosei;Kinoshita, Tomohiro
通讯作者：
Kinoshita, Tomohiro