Endocrine Abstracts

We present a case of a 73 year old female with recurrent non-functioning adenoma and co-existent mantle cell lymphoma within the pituitary fossa. Mantle cell lymphoma (MCL) is rare comprising around 6% of non-Hodgkin lymphoma diagnoses. It infrequently involves the central nervous system, with only one published case of involvement of the pituitary gland. Our patient initially presented in April 2003 with marked visual loss due to a large non-functioning cystic pituitary macroadenoma. She underwent successful transsphenoidal decompression in 2003 and continued to have regular surveillance scans. Over a period of 11 years there was evidence of slow regrowth of the residual adenoma, requiring further debulking surgery in 2007 and 2014. Later in 2017 the patient received a new diagnosis of MCL. This responded well to chemotherapy treatment going into complete remission. In early 2020 MCL recurrence was identified in the soft palate on positron emission tomography. Further repeat pituitary magnetic resonance imaging (MRI) in 2020, organised for routine surveillance, showed a substantial increase in size of the pituitary lesion impinging on the optic chiasm. The MRI reported rapid growth of the residual pituitary macroadenoma with the mass measuring 17 mm in the midline compared with 11 mm previously in 2018. There was significant reduction in the cerebrospinal fluid plane between the chiasm and the tumour. As a result of these findings the patient underwent further re-do transsphenoidal surgery in December 2020. She has since received radiotherapy and has been considered for Ibrutinib treatment. Notably, the latest pituitary histology results showed both non-functioning adenoma with evidence of MCL combined. This case highlights the importance of recognising alternate pathology with a rapidly growing pituitary adenoma, which previously was observed to slowly recur over several years. Review of other published literature suggests that this is an exceptionally rare case presentation.