Grossesse et hypophysite: une nouvelle observation

Introduction: L’hypophysite est une lésion hypophysaire rare qui pose des difficultés diagnostiques et thérapeutiques. Ses manifestations cliniques et radiologiques sont difficiles à distinguer des tumeurs hypophysaires.Observation: Nous rapportons, l’observation d’une femme âgée de 40 ans qui s’est présenté pour des céphalées, troubles visuels et vomissements au cours de son troisième trimestre de grossesse. L’imagerie par résonnance magnétique a montré une masse sellaire et supra sellaire de 21 mm et qui adhérait au chiasma optique. L’examen anatomopathologique réalisé après une chirurgie d’exérèse trans-sphénoïdale a montré un tissu fibreux associé à des lymphocytes et à des plasmocytes. Une nette amélioration clinique était obtenue après le traitement chirurgical, une corticothérapie et un traitement hormonal thyroïdien substitutif.Conclusion: L’hypophysite est une maladie rare et doit être considérée dans le diagnostic différentiel des désordres hypophysaires durant la grossesse.Mots clés: pseudotumeur inflammatoire, hypophysite, grossesse, IgG4English Title: Pregnancy and hypohpysitis: a case reportEnglish AbstractIntroducion: Hypophysitis is an uncommon sellar condition in which diagnosis and management pose a significant problem, as its clinical manifestation and radiological features are difficult to distinguish from that of pituitary tumors.Case report: We report, in this study, a case of 40 year-old woman presenting with headaches, vision disturbances and vomiting, during her third trimester. Magnetic resonance imaging (MRI) showed a 21 mm mass at the sellar and supra sellar regions, this mass adhered to the optic chiasm. Pathologic examination, after transsphenoïdal surgery revealed fibrous stroma with dense infiltrates of small lymphocytes and plasma cells. Resolution of the symptoms occured after surgery and replacement treatment by steroïds and physiological thyroxine.Conclusion: Hypophysitis is a rare diasease that should be considered in the differential diagnosis of pituitary disorders during pregnancy.Keywords: inflammatory pseudotumor ; hypophysitis ; pregnancy ; IgG

Thymic plasmacytoma presenting as polyneuropathy and revealing multiple myeloma: a case report

Abstract Background Multiple myeloma (MM) is the most frequent malignant plasma cell disorder with proliferation of neoplastic plasma cells in the bone marrow or other tissue, most commonly in the upper aerodigestive tract. The invasion of the thymus is exceptional. Neurological complications are usual, but represent exceptionally the revealing symptom. Case presentation We report a case of polyneuropathy revealing a thymic plasmacytoma as a mediastinal invasion of MM in a 48-year-old woman. She was admitted after developing progressive ascending distal paresthesias and weakness in lower limbs. Examination showed symmetrical distal sensorimotor impairment with axillary and inguinal adenopathies. Electroneuromyography revealed a sensorimotor length-dependent neuropathy. Serum protein electrophoresis showed monoclonal protein peak in β-γ globulin region. Immunoelectrophoresis showed IgA lambda monoclonal gammapathy. Myelogram and bone marrow biopsy revealed plasmocytosis of 5%. Chest computed tomography showed a histologically confirmed thymic plasmacytoma associated with a lytic lesion of the 5th rib leading to the diagnosis of MM. Conclusions The association between a thymic plasmacytoma and peripheral neuropathy is rare and a workup for MM is necessary to guide therapeutic management