Walsh & Hoyt: Mimics of Pituitary Adenomas

Primary lymphoma of the central nervous system may present as sixth nerve palsy or hypopituitarism and appear as a sellar and suprasellar mass on neuroimaging. The differential diagnosis of sellar masses also includes craniopharyngioma, meningioma, germinoma and other germ cell tumors, schwannoma, infundibular glioma and pituicytoma, cysts (dermoid, epidermoid, Rathkes cleft, arachnoid, cysticercus), sarcoidosis, histiocytosis, xanthogranuloma, infections (fungi, parasites, syphilis, and tuberculosis), and aneurysm. The differential diagnosis can usually be narrowed by MR imaging, but sophisticated pathology may be required for definitive diagnosis.