Intrasellar plasmacytoma presenting as a non-functional invasive pituitary macro-adenoma

Case report and literature review

Bridget P. Sinnott, B. Hatipoglu, D. H. Sarne

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

We report an uncommon case of an intrasellar plasmacytoma presenting as a non-functional invasive pituitary macro-adenoma as the first manifestation of multiple myeloma. A 57 year old woman was referred to our department with a presumed diagnosis of a non-functioning pituitary macro-adenoma. She reported a 3 month history of headaches and a 2 week history of sudden onset of right facial numbness. Preoperative endocrine evaluation was remarkable only for a modestly elevated serum prolactin. A magnetic resonance imaging (MRI) scan revealed 3.6 × 5 × 4 cm enhancing homogeneous intrasellar mass with extension into the sphenoid and cavernous sinuses bilaterally; the optic chiasm was not displaced. She underwent transphenoidal surgery of the sellar lesion. The surgical specimen was heavily infiltrated with abnormal plasma cells, which stained almost exclusively for Kappa light chain immunoglobulins. An extensive investigation was undertaken to look for occult myelomatous disease. A diagnosis of multiple myeloma was made 1 month later based on a combination of clinical, pathological and radiologic features. She underwent radiation therapy directed towards the residual sellar tumor, followed by chemotherapy and autologous stem cell transplantation. Review of the world literature revealed only 22 previous reports of patients in whom a solitary plasmacytoma or multiple myeloma first presented as a sellar mass; in all cases mimicking clinically and radiologically a non-functioning invasive pituitary adenoma however with additional cranial nerve involvement. Intrasellar plasma cell tumors are rare tumors which may mimic non-functioning invasive pituitary tumors. The diagnosis should be suspected in patients with well preserved anterior pituitary function and cranial nerve neuropathies in the presence of significant sellar destruction.

Original languageEnglish (US)
Pages (from-to)65-72
Number of pages8
JournalPituitary
Volume9
Issue number1
DOIs
StatePublished - Mar 1 2006
Externally publishedYes

Fingerprint

Plasmacytoma
Pituitary Neoplasms
Multiple Myeloma
Cranial Nerves
Immunoglobulin kappa-Chains
Sphenoid Sinus
Optic Chiasm
Cranial Nerve Diseases
Cavernous Sinus
Hypesthesia
Residual Neoplasm
Stem Cell Transplantation
Plasma Cells
Prolactin
Headache
Radiotherapy
Magnetic Resonance Imaging
Drug Therapy
Serum
Neoplasms

Keywords

  • Multiple myeloma
  • Pituitary adenoma
  • Plasmacytoma

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Intrasellar plasmacytoma presenting as a non-functional invasive pituitary macro-adenoma : Case report and literature review. / Sinnott, Bridget P.; Hatipoglu, B.; Sarne, D. H.

In: Pituitary, Vol. 9, No. 1, 01.03.2006, p. 65-72.

Research output: Contribution to journalArticle

@article{40c54197185346629a22c417b04249c4,
title = "Intrasellar plasmacytoma presenting as a non-functional invasive pituitary macro-adenoma: Case report and literature review",
abstract = "We report an uncommon case of an intrasellar plasmacytoma presenting as a non-functional invasive pituitary macro-adenoma as the first manifestation of multiple myeloma. A 57 year old woman was referred to our department with a presumed diagnosis of a non-functioning pituitary macro-adenoma. She reported a 3 month history of headaches and a 2 week history of sudden onset of right facial numbness. Preoperative endocrine evaluation was remarkable only for a modestly elevated serum prolactin. A magnetic resonance imaging (MRI) scan revealed 3.6 × 5 × 4 cm enhancing homogeneous intrasellar mass with extension into the sphenoid and cavernous sinuses bilaterally; the optic chiasm was not displaced. She underwent transphenoidal surgery of the sellar lesion. The surgical specimen was heavily infiltrated with abnormal plasma cells, which stained almost exclusively for Kappa light chain immunoglobulins. An extensive investigation was undertaken to look for occult myelomatous disease. A diagnosis of multiple myeloma was made 1 month later based on a combination of clinical, pathological and radiologic features. She underwent radiation therapy directed towards the residual sellar tumor, followed by chemotherapy and autologous stem cell transplantation. Review of the world literature revealed only 22 previous reports of patients in whom a solitary plasmacytoma or multiple myeloma first presented as a sellar mass; in all cases mimicking clinically and radiologically a non-functioning invasive pituitary adenoma however with additional cranial nerve involvement. Intrasellar plasma cell tumors are rare tumors which may mimic non-functioning invasive pituitary tumors. The diagnosis should be suspected in patients with well preserved anterior pituitary function and cranial nerve neuropathies in the presence of significant sellar destruction.",
keywords = "Multiple myeloma, Pituitary adenoma, Plasmacytoma",
author = "Sinnott, {Bridget P.} and B. Hatipoglu and Sarne, {D. H.}",
year = "2006",
month = "3",
day = "1",
doi = "10.1007/s11102-006-8281-9",
language = "English (US)",
volume = "9",
pages = "65--72",
journal = "Pituitary",
issn = "1386-341X",
publisher = "Kluwer Academic Publishers",
number = "1",

}

TY - JOUR

T1 - Intrasellar plasmacytoma presenting as a non-functional invasive pituitary macro-adenoma

T2 - Case report and literature review

AU - Sinnott, Bridget P.

AU - Hatipoglu, B.

AU - Sarne, D. H.

PY - 2006/3/1

Y1 - 2006/3/1

N2 - We report an uncommon case of an intrasellar plasmacytoma presenting as a non-functional invasive pituitary macro-adenoma as the first manifestation of multiple myeloma. A 57 year old woman was referred to our department with a presumed diagnosis of a non-functioning pituitary macro-adenoma. She reported a 3 month history of headaches and a 2 week history of sudden onset of right facial numbness. Preoperative endocrine evaluation was remarkable only for a modestly elevated serum prolactin. A magnetic resonance imaging (MRI) scan revealed 3.6 × 5 × 4 cm enhancing homogeneous intrasellar mass with extension into the sphenoid and cavernous sinuses bilaterally; the optic chiasm was not displaced. She underwent transphenoidal surgery of the sellar lesion. The surgical specimen was heavily infiltrated with abnormal plasma cells, which stained almost exclusively for Kappa light chain immunoglobulins. An extensive investigation was undertaken to look for occult myelomatous disease. A diagnosis of multiple myeloma was made 1 month later based on a combination of clinical, pathological and radiologic features. She underwent radiation therapy directed towards the residual sellar tumor, followed by chemotherapy and autologous stem cell transplantation. Review of the world literature revealed only 22 previous reports of patients in whom a solitary plasmacytoma or multiple myeloma first presented as a sellar mass; in all cases mimicking clinically and radiologically a non-functioning invasive pituitary adenoma however with additional cranial nerve involvement. Intrasellar plasma cell tumors are rare tumors which may mimic non-functioning invasive pituitary tumors. The diagnosis should be suspected in patients with well preserved anterior pituitary function and cranial nerve neuropathies in the presence of significant sellar destruction.

AB - We report an uncommon case of an intrasellar plasmacytoma presenting as a non-functional invasive pituitary macro-adenoma as the first manifestation of multiple myeloma. A 57 year old woman was referred to our department with a presumed diagnosis of a non-functioning pituitary macro-adenoma. She reported a 3 month history of headaches and a 2 week history of sudden onset of right facial numbness. Preoperative endocrine evaluation was remarkable only for a modestly elevated serum prolactin. A magnetic resonance imaging (MRI) scan revealed 3.6 × 5 × 4 cm enhancing homogeneous intrasellar mass with extension into the sphenoid and cavernous sinuses bilaterally; the optic chiasm was not displaced. She underwent transphenoidal surgery of the sellar lesion. The surgical specimen was heavily infiltrated with abnormal plasma cells, which stained almost exclusively for Kappa light chain immunoglobulins. An extensive investigation was undertaken to look for occult myelomatous disease. A diagnosis of multiple myeloma was made 1 month later based on a combination of clinical, pathological and radiologic features. She underwent radiation therapy directed towards the residual sellar tumor, followed by chemotherapy and autologous stem cell transplantation. Review of the world literature revealed only 22 previous reports of patients in whom a solitary plasmacytoma or multiple myeloma first presented as a sellar mass; in all cases mimicking clinically and radiologically a non-functioning invasive pituitary adenoma however with additional cranial nerve involvement. Intrasellar plasma cell tumors are rare tumors which may mimic non-functioning invasive pituitary tumors. The diagnosis should be suspected in patients with well preserved anterior pituitary function and cranial nerve neuropathies in the presence of significant sellar destruction.

KW - Multiple myeloma

KW - Pituitary adenoma

KW - Plasmacytoma

UR - http://www.scopus.com/inward/record.url?scp=33646700046&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33646700046&partnerID=8YFLogxK

U2 - 10.1007/s11102-006-8281-9

DO - 10.1007/s11102-006-8281-9

M3 - Article

VL - 9

SP - 65

EP - 72

JO - Pituitary

JF - Pituitary

SN - 1386-341X

IS - 1

ER -