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T cell lymphoblastic lymphoma/leukemia within an adrenocorticotropic hormone and thyroid stimulating hormone positive pituitary adenoma: A cytohistological correlation emphasizing importance of intra-operative squash smear.
- Source :
-
Neuropathology : official journal of the Japanese Society of Neuropathology [Neuropathology] 2017 Aug; Vol. 37 (4), pp. 358-364. Date of Electronic Publication: 2017 Mar 13. - Publication Year :
- 2017
-
Abstract
- We present a rare case of primary pituitary T cell lymphoma/leukemia (T-LBL) in association with adrenocorticotropic hormone (ACTH) and thyroid stimulating hormone (TSH) expressing pituitary adenoma in a 55-year-old woman highlighting the importance of intra-operative squash smears examination. The patient presented with complaints of headache, diminution of vision and recent onset altered sensorium. MRI revealed a mass lesion in the sellar-suprasellar region with non-visualization of pituitary gland separately, extending to involve adjacent structures diagnosed as invasive pituitary macroadenoma. Intra-operative tissue was sent for squash smear examination. The cytology showed a tumor comprising of sheets of immature lymphoid cells intermixed with clusters of pituitary acinar cells with many mitoses and tingible body macrophages. A diagnosis of presence of immature lymphoid cells within the pituitary was offered and differentials of infiltration by lymphoma cells from systemic disease versus primary central nervous lymphoma-like lymphoma arising in the pituitary adenoma were considered. Later paraffin section examination and immunohistochemistry corroborated with the squash findings and a final diagnosis of primary pituitary T cell lymphoma/leukemia in association with ACTH and TSH expressing pituitary adenoma was made. To date, only six cases of primary pituitary T cell lymphomas, including three T-LBL cases, have been reported. This is the seventh case and first one additionally describing cytohistological correlation and importance of intra-operative cytology.<br /> (© 2017 Japanese Society of Neuropathology.)
- Subjects :
- Adenoma pathology
Adrenocorticotropic Hormone biosynthesis
Female
Humans
Middle Aged
Neoplasms, Multiple Primary pathology
Pituitary Neoplasms pathology
Precursor Cell Lymphoblastic Leukemia-Lymphoma pathology
Thyrotropin biosynthesis
Adenoma diagnosis
Cytodiagnosis methods
Neoplasms, Multiple Primary diagnosis
Pituitary Neoplasms diagnosis
Precursor Cell Lymphoblastic Leukemia-Lymphoma diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1440-1789
- Volume :
- 37
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Neuropathology : official journal of the Japanese Society of Neuropathology
- Publication Type :
- Report
- Accession number :
- 28295636
- Full Text :
- https://doi.org/10.1111/neup.12375