Combined chronic lymphocytic leukemia and prolactinoma: a rare occurrence in a patient presenting with pituitary apoplexy

Case report

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The authors describe a rare case of combined pituitary chronic lymphocytic leukemia (CLL) and prolactinoma in a 77-year-old man presenting with apoplexy. This case highlights the importance of evaluating the pituitary gland in patients with CLL who present with clinical manifestations of apoplexy as well as the need to carefully evaluate pathological specimens from the gland for the presence of lymphocytic cells in those patients. This is the first reported case of a combined CLL–prolactinoma pituitary lesion presenting with apoplexy.

Abbreviation used in this paper:CLL = chronic lymphocytic leukemia.

Article Information

Address correspondence to: William T. Couldwell, M.D., Ph.D., Department of Neurosurgery, University of Utah, 175 North Medical Drive East, Salt Lake City, Utah 84132. email:

Please include this information when citing this paper: published online May 17, 2013; DOI: 10.3171/2013.4.JNS122041.

© AANS, except where prohibited by US copyright law.



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    Axial CT scans of the patient's head. A: Images without contrast enhancement demonstrating a large isodense expansile sellar lesion with patchy areas of hyperdensity within the sellar portion of the lesion, suggestive of acute hemorrhage. B: Images showing suprasellar extension and left cavernous sinus invasion, as well as erosion of the sellar floor and left sphenoid wing, including the foramen rotundum and vidian canal.

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    Magnetic resonance imaging obtained in the patient. Coronal and axial T1-weighted MR images with Gd enhancement (A) demonstrate a large, minimally enhancing tumor measuring 4.0 ×3.7 ×3.7 cm located within an expanded sella and extending into the adjacent suprasellar compartment, compressing both the pituitary stalk and optic chiasm, and into the left cavernous sinus space, encasing the left internal carotid artery. Axial and sagittal T1-weighted (B) and axial T2-weighted MR images without contrast enhancement (C) reveal acute and chronic hemorrhage of mixed ages.

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    Photomicrographs demonstrating fragments of pituitary adenoma surrounded by acute hemorrhage (A) as well as intermingled, small, monotonous lymphocytic cells (B); H & E. Immunohistochemical analysis revealed all of the lymphocytes to be positive for CD5 (C), and the majority were CD20 positive. The pituitary adenoma cells were prolactin positive (D) but negative for adrenocorticotropic hormone and growth hormone. Original magnification ×400 (A–D).


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