case_images: PMC9941690_01
case_images: (A-C) Head MRI: the sella was expanded, with an oval slightly long T1 and long T2 abnormal signal, and there was uneven enhancement and a clear boundary. The neurohypophysis is clearly shown, the left optic chiasm is compressed, and the internal carotid artery in the left cavernous sinus is partially surrounded. The intracranial segment of the left optic nerve were compressed and slightly thinned, and the enhanced scan showed mild enhancement; (D) Head CT: the sella is enlarged, high-density nodules are seen in the pituitary fossa, the size is about 2.1*2.8cm, and the CT value is about 56HU; (E) The tumor was found to have abundant blood supply during the operation; (F) Pathological section: Proliferating tumor cells and have a starry sky appearance and they are dense, with medium cell volume, thin cytoplasm, large and slightly irregular nuclei, and fine chromatin; (G, H) Flow cytometry, and we found that B lymphocytes with CD19+CD20+ accounted for about 19.8% of lymphocytes, with polyclonal expression of Kappa and Lambda; (I) Postoperative re-examination of head MRI showed no tumor recurrence.
case_images: fonc-13-1087232-g001.jpg
case_images: PMC9941690_01_fonc-13-1087232-g001.jpg
case_images: f1
case_images: He underwent MRI at another hospital 2 days before admission; Results showed that the sella was expanded, with an oval slightly long T1 and long T2 abnormal signal, and there was uneven enhancement and a clear boundary; The lesion size was 2.16x1.60x2.16cm ( Figures 1A-C ). CT of the head showed that a hyperdense nodules can be seen inside the pituitary fossa ( Figure 1D ). We found the tumor had an outer envelope, with tough texture and a very rich blood supply during surgery ( Figure 1E ). Pathological results: B-lymphoblastic lymphoma ( Figure 1F ). BCL-6(+), BCL-2(> 90% +), LMO2(+), PAX5(+), CD99(+), CD20(-). Bone marrow specimens were evaluated by flow cytometry, and we found that B lymphocytes with CD19+CD20+ accounted for about 19.8% of lymphocytes, with polyclonal expression of Kappa and Lambda ( Figures 1G, H ), but no obvious abnormal immunophenotype cells were found. October 2022 ( Figure 1I ). On October 26, 2022, the patient had a re-examination of PET/CT and found that the increased FDG uptake in his both kidneys, ureters, prostate, pelvis, and left femoral head and neck were reduced compared with the previous range, and the extent of lymphoma involvement was relieved.