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Naito K, Suzuki S, Ohwada C, Ishiwata K, Ruike Y, Ishida A, Deguchi-Horiuchi H, Fujimoto M, Koide H, Sakaida E, Horiguchi K, Iwadate Y, Tatsuno I, Inoshita N, Ikeda JI, Tanaka T, Yokote K. ICAM1-Negative Intravascular Large B-Cell Lymphoma of the Pituitary Gland: A Case Report and Literature Review. AACE Clin Case Rep 2021; 7:249-255. [PMID: 34307847 PMCID: PMC8282537 DOI: 10.1016/j.aace.2021.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive type of B-cell lymphoma with large cells growing within the lumen of blood vessels. Although previous reports revealed highly variable symptoms resulting from small-vessel occlusion by neoplastic cells in a variety of organs, there are few reports of IVLBCL with pituitary involvement. Method We present a case of IVLBCL with pituitary infiltration from our institution together with a literature review of similar cases to better understand this rare case of IVLBCL involving the pituitary gland. Results Our case and the pertinent literature demonstrated that IVLBCL with pituitary involvement predominantly occurred in women at a mean age of 64 years, and most of them showed panhypopituitarism that was reversible after standard therapy of rituximab-containing chemotherapy with intrathecal methotrexate. Notably, the pituitary biopsy in our case revealed that atypical large B-cells found within blood vessels and the pituitary gland were negative for intercellular adhesion molecule 1. Intercellular adhesion molecule 1-negative lymphoid cells may have contributed to panhypopituitarism by extravasation into the pituitary tissues, which do not have a blood-brain barrier and receive abundant blood flow. Conclusion IVLBCL of the pituitary gland is a rare lymphoma with nonspecific manifestations and a dismal prognosis. Recognition of the clinicopathological features is necessary for early clinical diagnosis and appropriate treatment.
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Key Words
- ACTH, adrenocorticotropic hormone
- BAL, bronchoalveolar lavage fluid analysis
- CRH, corticotropin-releasing hormone
- FDG, 18F-fluorodeoxyglucose
- FSH, follicle-stimulating hormone
- GH, growth hormone
- GHRP2, growth hormone-releasing peptide 2
- ICAM1
- ICAM1, intercellular adhesion molecule 1
- IVLBCL, intravascular large B-cell lymphoma
- LDH, lactate dehydrogenase
- LH, luteinizing hormone
- LHRH, luteinizing hormone-releasing hormone
- MEAM, ranimustine, etoposide, cytarabine, and melphalan
- MTX, methotrexate
- R-CHOP, rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone
- R-hyper-CVAD/MA, rituximab plus hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine
- TBLB, transbronchial lung biopsy
- TRH, thyrotropin-releasing hormone
- TSH, thyrotropin
- hypopituitarism
- intravascular
- large B-cell lymphoma
- pituitary
- sIL2R, soluble IL-2 receptor
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Affiliation(s)
- Kumiko Naito
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Sawako Suzuki
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Chikako Ohwada
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Hematology, Chiba University Hospital, Chiba, Japan
| | - Kazuki Ishiwata
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Yutaro Ruike
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Akiko Ishida
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Hanna Deguchi-Horiuchi
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Masanori Fujimoto
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Hisashi Koide
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Emiko Sakaida
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Hematology, Chiba University Hospital, Chiba, Japan
| | - Kentaro Horiguchi
- Department of Neurological Surgery, Chiba University Hospital, Chiba, Japan
| | - Yasuo Iwadate
- Department of Neurological Surgery, Chiba University Hospital, Chiba, Japan
| | - Ichiro Tatsuno
- Center for Diabetes, Metabolism and Endocrinology, Toho University Sakura Medical Center, Chiba, Japan
| | - Naoko Inoshita
- Department of Pathological Diagnosis, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Jun-Ichiro Ikeda
- Department of Pathology, Chiba University Hospital, Chiba, Japan
| | - Tomoaki Tanaka
- Department of Molecular Diagnosis, Chiba University, Chiba, Japan
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
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