case_images: PMC10828736_01
case_images: Pre- and postoperative MRI and ophthalmological examination of the patient.. A) Initial coronal T1-weighted contrast-enhanced magnetic resonance imaging (MRI) scan reveals Knosp grade 4 pituitary lesion. B) Coronal T1-weighted contrast-enhanced MRI scan obtained a month after the initial MRI reveals that the tumor significantly increased in size (from 12.4 x 28.2 mm to 14.2 x 31.6 mm). Coronal (C) and sagittal (D) T1-weighted contrast-enhanced MRI scans obtained in the second postoperative month revealed almost complete disappearance of the tumor. E) Preoperative ophthalmological examination reveals total ophthalmoplegia, which completely resolved (F) in the second postoperative month. White arrow: optic chiasm, P: primary pituitary lymphoma, asterisk: internal carotid artery, H: hypophyseal fossa, black arrow: pituitary stalk.
case_images: cureus-0016-00000051478-i01.jpg
case_images: PMC10828736_01_cureus-0016-00000051478-i01.jpg
case_images: FIG1
case_images: A neurological examination revealed total ophthalmoplegia, accompanied by a loss of visual acuity in the left eye and mild hypoesthesia on the left side of her face (Figure 1E). Notably, a complete invasion of the left cavernous sinus was observed, classified as Knosp grade 4 (Figure 1A). A follow-up MRI scan revealed that the lesion had increased in size (from 12.4 x 28.2 mm to 14.2 x 31.6 mm) (Figure 1B). At the two-month follow-up, an MRI scan revealed a near-complete resolution of the tumor (Figures 1C-1D). The patient's ophthalmoplegia and headache had resolved completely at the two-month follow-up, and at the four-month follow-up, she was symptom-free and had normal endocrinological function (Figure 1F).
case_images: Pathological specimen.. (A,B) Biopsy sample obtained from the pituitary gland shows diffuse atypical lymphoid infiltration (hemotoxylin and eosin, x200; x400). (C) Residual pituitary cells stain positively for synaptophysin (x200). (D,E) Immunohistochemical examination reveals positive staining for CD20 and MUM1 in the lymphoid cells (x200). (F) Proliferative activity of 80% is observed with Ki67 (x200).
case_images: cureus-0016-00000051478-i02.jpg
case_images: PMC10828736_01_cureus-0016-00000051478-i02.jpg
case_images: FIG2
case_images: Additionally, lymphoid cell infiltration was observed between the bony trabeculae (Figure 2).