RESUMO
BACKGROUND: Primary pituitary lymphoma (PPL) is a rare finding in immunocompetent patients, with only 54 patients reported to date (including ours). It presents most often with headache and hypopituitarism, with MRI findings comparable to more common pituitary tumours, making the diagnosis challenging. There is no consensus on the ideal management for these lesions with the role of surgical resection not clearly established. CASE REPORT: We present here a 49-year-old female who presented with acute vision loss and was found to have PPL of diffuse large B-cell lymphoma, non-germinal centre type. The radiologic findings were distinct from prior cases with haemorrhagic components and perilesional edoema in the bilobed sellar mass. Surgical resection was halted when a diagnosis of lymphoma was suspected. This decision was based on the guidelines for the treatment of primary CNS lymphoma (PCNSL) and the lack of evidence to support surgical resection of PPL specifically. Our patient lacked mutations commonly associated with a poor prognosis in DLBCL, such as TP53 and BCL6. She remains in remission with normal vision nearly two years after treatment with minimal resection, MR-CHOP, and consolidation radiotherapy. CONCLUSION: We highlight here the clinical and diagnostic features of PPL to guide clinicians to early recognition and diagnosis. Surgical resection should be limited to what is necessary to obtain a diagnosis and critical decompression; otherwise, these lesions respond excellently to steroids and typical chemoradiation regimens.
RESUMO
BACKGROUND: Primary lymphomas arising in peripheral nerves are extremely rare, with just a few case reports documented in the literature. OBSERVATIONS: The authors present the case of a 62-year-old female with C8 radiculopathy, initially suspected to have a schwannoma based on imaging but later diagnosed with primary C8 nerve root B-cell lymphoma. Following histopathological confirmation, the patient underwent 5 courses of chemotherapy, resulting in a decrease in the size of her lesion on magnetic resonance imaging. At her clinical follow-up 3 months later, her symptoms had improved. After performing a systematic review of the literature while adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines, the authors found only 3 similar cases, each with atypical presentations and treated with various chemotherapeutic agents and one of which experienced a central nervous system recurrence. LESSONS: These cases highlight the importance of early and accurate diagnosis for optimal management and long-term vigilance of primary lymphomas in the peripheral nerve. https://thejns.org/doi/10.3171/CASE24338.