Related Experiment Videos
Hypophyseal non-Hodgkin's lymphoma presenting with diabetes insipidus: a case report
E M Merlo1, A Maiolo, A Brocchieri
1Department of Internal Medicine, University of Pavia, IRCCS Policlinico S. Matteo, Italy.
Insights
This case study highlights a rare instance of non-Hodgkin's lymphoma spreading to the pituitary gland, causing diabetes insipidus. Aggressive chemotherapy led to a favorable outcome, emphasizing its efficacy in treating central nervous system lymphoma.
Area of Science:
- Oncology
- Neurology
- Pathology
Background:
- Non-Hodgkin's lymphoma is a diverse group of lymphoid malignancies.
- Central nervous system involvement by lymphoma is uncommon but serious.
- Pituitary gland involvement presents with unique clinical manifestations.
Observation:
- A 64-year-old male with ischemic heart disease presented with an abdominal mass, diagnosed as high-grade non-Hodgkin's lymphoma.
- Following initial chemotherapy (COP) and radiotherapy, the patient achieved partial remission.
- Recurrence manifested as axillary lymphadenopathy, polydipsia, and polyuria, with a detected pituitary mass on NMR.
Findings:
- The patient's symptoms were attributed to hypophyseal localization of non-Hodgkin's lymphoma, a rare form of central nervous system spread.
- Treatment with desmopressin (DDAVP) and aggressive chemotherapy (PRO-MACE) resolved symptoms and significantly reduced the pituitary mass.
- This case underscores the potential for favorable outcomes with intensive chemotherapy in CNS lymphoma.
Implications:
- Highlights the importance of considering rare metastatic sites in lymphoma recurrence.
- Demonstrates the effectiveness of aggressive chemotherapy regimens in managing CNS lymphoma.
- Suggests potential limitations of radiotherapy in CNS lymphoma due to risks of late neurological sequelae.
Abstract:
We report the case of a 64 year old male patient with a history of ischemic heart disease who underwent surgery for an abdominal mass. The histological diagnosis was highly malignant non-Hodgkin's lymphoma. After surgery the patient was admitted to our Department and received 6 courses of chemotherapy according to the COP schedule, followed by radiotherapy to the left upper abdominal region and ipsilateral lung base. The patient achieved partial remission. One month later he began to complain of left axillary lymphadenomegaly, polydipsia and polyuria. A NMR brain scan showed a hypophyseal mass. The patient was treated with DDAVP and chemotherapy with the PRO-MACE protocol; the polyuria and lymphadenomegaly disappeared and the size of the hypophyseal mass reduced markedly. The clinical picture was, therefore, attributed to a hypophyseal localization of the non-Hodgkin's lymphoma, which is a very rare manifestation of lymphomatous spread to the central nervous system. Our case is also interesting because it shows that a favorable outcome can be obtained with chemotherapy, provided that the latter is sufficiently aggressive. This is not necessarily the case with radiotherapy which may also be followed by late and severe neurologic sequelae.