Symptomatic hypopituitarism revealing primary suprasellar lymphoma

Area of Science:

• Neuroendocrinology
• Neuropathology
• Oncology

Background:

• Pituitary adenomas are the most common cause of hypopituitarism.
• Suprasellar masses can have diverse etiologies beyond pituitary adenomas.
• Primary suprasellar lymphoma is an exceptionally rare cause of hypopituitarism.

Purpose of the Study:

• To report an unusual case of primary suprasellar lymphoma presenting with hypopituitarism.
• To highlight the diagnostic challenges posed by rare suprasellar masses.
• To emphasize the importance of considering lymphoma in the differential diagnosis of suprasellar lesions.

Main Methods:

• Case presentation of a 26-year-old woman with amenorrhea, galactorrhea, and neurological symptoms.
• Laboratory work-up confirmed partial hypopituitarism.
• Magnetic resonance imaging (MRI) revealed a suprasellar mass, initially presumed to be granulomatous.
• Steroid therapy led to regression of the suprasellar mass but new brain lesions appeared.
• Stereotactic biopsy of a paraventricular lesion diagnosed B-cell lymphoma.

Main Results:

• The patient presented with symptoms of hypopituitarism and neurological disorders.
• Initial imaging identified a suprasellar mass.
• Treatment for a presumed granulomatous process resulted in paradoxical findings.
• Histopathological analysis confirmed primary B-cell lymphoma as the cause.

Conclusions:

• Primary suprasellar lymphoma is a rare and challenging diagnosis.
• Suprasellar masses require careful radiological assessment due to varied etiologies.
• Given the rising incidence of primary CNS lymphoma (PCNSL), it should be considered in the differential diagnosis of suprasellar region lesions.