title: 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.
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.
authors.affiliation: Department of Pathology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Gupta
authors.affiliation: Department of Pathology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
authors.forename: Ravindra K
authors.identifier: http://orcid.org/0000-0001-9146-5783
authors.initials: RK
authors.lastname: Saran
authors.affiliation: Department of Neurosurgery, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
authors.forename: Arvind K
authors.initials: AK
authors.lastname: Srivastava
authors.affiliation: Department of Neurosurgery, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Jagetia
authors.affiliation: Department of Radiodiagnosis, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
authors.forename: Lalit
authors.initials: L
authors.lastname: Garg
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Mehar C
authors.initials: MC
authors.lastname: Sharma
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000324:Adrenocorticotropic Hormone / Q000096:biosynthesis; D003581:Cytodiagnosis / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000473:pathology; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000473:pathology; D013972:Thyrotropin / Q000096:biosynthesis
chemical_list: D000324:Adrenocorticotropic Hormone; D013972:Thyrotropin
keywords: ACTH; T -cell; TSH; lymphoblastic lymphoma/leukemia; pituitary adenoma