Rethinking the role of surgical resection in the management of primary pituitary lymphoma.

Autor: Filo J; Harvard Medical School, Boston, MA, USA., Zhao M; Harvard Medical School, Boston, MA, USA., Orrego-Gonzalez E; Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA., Schwartz SN; Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA., White B; Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA., Varma H; Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA., Vega RA; Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Jazyk: angličtina
Zdroj: British journal of neurosurgery [Br J Neurosurg] 2024 Aug 23, pp. 1-5. Date of Electronic Publication: 2024 Aug 23.
DOI: 10.1080/02688697.2024.2395369
Abstrakt: Background: Primary pituitary lymphoma (PPL) is a rare finding in immunocompetent patients, with only 54 patients reported to date (including ours). It presents most often with headache and hypopituitarism, with MRI findings comparable to more common pituitary tumours, making the diagnosis challenging. There is no consensus on the ideal management for these lesions with the role of surgical resection not clearly established.
Case Report: We present here a 49-year-old female who presented with acute vision loss and was found to have PPL of diffuse large B-cell lymphoma, non-germinal centre type. The radiologic findings were distinct from prior cases with haemorrhagic components and perilesional edoema in the bilobed sellar mass. Surgical resection was halted when a diagnosis of lymphoma was suspected. This decision was based on the guidelines for the treatment of primary CNS lymphoma (PCNSL) and the lack of evidence to support surgical resection of PPL specifically. Our patient lacked mutations commonly associated with a poor prognosis in DLBCL, such as TP53 and BCL6. She remains in remission with normal vision nearly two years after treatment with minimal resection, MR-CHOP, and consolidation radiotherapy.
Conclusion: We highlight here the clinical and diagnostic features of PPL to guide clinicians to early recognition and diagnosis. Surgical resection should be limited to what is necessary to obtain a diagnosis and critical decompression; otherwise, these lesions respond excellently to steroids and typical chemoradiation regimens.
Databáze: MEDLINE
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