title: Concomitant Primary CNS Lymphoma and FSH-Pituitary Adenoma Arising Within the Sella. Entirely Coincidental?
abstract: Collision tumors are the simultaneous occurrence of more than one type of neoplasm within an anatomic space. In the pituitary sella, collision tumors are exceedingly rare, and not much is known about their etiology and prognosis.
  
  
  
  A 74-year-old man presented with a concomitant primary pituitary lymphoma (diffuse large B-cell non-Hodgkin's lymphoma; DLBCL) and follicle-stimulating hormone (FSH)-adenoma diagnosed histologically after clinical features of apoplexy prompted urgent surgical decompression and resection. Strong immunoreactivity for FSH by the lymphoma was evident. Full-body workup demonstrated no other source for the lymphoma. He subsequently underwent 4 cycles of chemotherapy and has been in remission for over 32 months. His ophthalmoplegia at presentation persisted with no further deficits.
  
  
  
  Four cases of collision tumors of primary pituitary lymphoma and adenoma have previously been reported. This case represents the first combination of an FSH-adenoma and a DLBCL in the literature. Prompt involvement of the hematology-oncology team contributed to the good outcome seen in this case. The putative role played by pituitary hormones in tumorigenesis is reviewed in this case report. The association is either a chance occurrence or due to the induction of lymphoma cell proliferation by the binding of FSH produced by the adenoma to the FSH receptors on the lymphoma cells.
authors.affiliation: Division of Neurosurgery, Addenbroo-ke's Hospital, Cambridge, UK.
authors.forename: Vin Shen
authors.initials: VS
authors.lastname: Ban
authors.affiliation: Division of Neurosurgery, Addenbroo-ke's Hospital, Cambridge, UK.
authors.forename: Bedansh Roy
authors.initials: BR
authors.lastname: Chaudhary
authors.affiliation: Depart-ment of Histopathology, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Kieren
authors.initials: K
authors.lastname: Allinson
authors.affiliation: Division of Neurosurgery, Addenbroo-ke's Hospital, Cambridge, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Santarius
authors.affiliation: Division of Neurosurgery, Addenbroo-ke's Hospital, Cambridge, UK.
authors.forename: Ramez Wadie
authors.initials: RW
authors.lastname: Kirollos
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000601:surgery*; D000368:Aged; D005640:Follicle Stimulating Hormone; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D010902:Pituitary Gland / Q000473:pathology; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000601:surgery*
chemical_list: D005640:Follicle Stimulating Hormone
keywords: Apoplexy; Diffuse large B-cell lymphoma; Follicle-stimulating hormone; Gonadotroph; Lymphoma; Macroadenoma; Pituitary