Primary Pituitary Lymphoma—Case Report and Review of Literature

Objective and Importance: Primary central nervous system lymphoma (PCNSL) is a disease that is being reported with increasing frequency. Similarly, the number of cases of primary pituitary lymphoma (PPL) has been increasing with a rise in the number of case reports over the past decade. The diagnosis is rarely suspected initially due to similar radiological presentation with meningiomas and other intrasellar masses. The treatment, however, is quite different from the other lesions, and follows mostly a conservative therapy. Case report: A 73-year-old male patient, presenting initially with headache, diplopia, and third nerve palsy. Meningioma was the initial presumptive diagnosis. However, the diagnosis was challenged in a multidisciplinary colloquium, and the diagnosis of PPL was posed and was confirmed by a transsphenoidal biopsy. The patient underwent successful medical therapy for his lymphoma. Methods: We conducted a review of literature using PubMed for cases described with primary pituitary lymphoma. We found a total of 33 cases up to this date, including ours. Data were presented in a table with the patient clinical presentation, physical exam, initial presumed diagnosis, and final diagnosis based on histopathology report. Discussion: The patients with PPL had similar epidemiology and characteristics of those with PCNSL. Note that in the review of literature conducted, the majority of the cases described were initially misdiagnosed, which often lead to unnecessary surgical interventions or treatments. The increasing frequency of PPL in immunocompetent patients poses a diagnostic challenge, given its similarity to other lesions and the extensive differential diagnosis list. Conclusion: Correct diagnosis cannot be obtained based only on imaging and clinical findings, a frequently encountered error described in the literature in correlation with the rising frequency of PPL. Thus, pathological and histological analysis, associated with a multidisciplinary approach, ensures optimal care for the patients.