Lymphocytic hypophysitis with cystic MRI appearance

Lymphocytic hypophysitis (LH) is an infrequent primary inflammatory disorder, which is usually diagnosed after surgery for lesions suspected to be pituitary adenomas. Some radiological features have been described that may allow a preoperative diagnosis, such as a symmetric enlargement of the gland with diffuse contrast enhancement extending to the basal hypothalamus in a tongue-like fashion. We describe the case of a patient with LH presenting with the MR imaging of a cystic lesion with ring contrast enhancement. It seems that this appearance in imaging studies is not unusual, and should be considered among the features suggesting this disease in an appropriate clinical context.