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Pituitary adenoma, null cell type involving clivus

Case contributed by: Dr Frank Gaillard

From the case: Pituitary adenoma, null cell type involving clivus

Modality: MRI

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Macroadenoma T1

Case Discussion:

MRI centred on the pituitary demonstrates a large mass which involves the clivus, pituitary fossa and extends both anteriorly into the sphenoid sinus and superiorly into the suprasellar cistern, elevating and distorting the chiasm and floor of the third ventricle. No normal pituitary can be identified.

It is isodense on T1 with moderate heterogeneous enhancement. Many small areas of high T2 signal as scattered throughout the mass.

Histological diagnosis: Pituitary adenoma, null cell type.

Given the high T2 signal the possibility of this mass representing a chordoma was entertained.

Final Diagnosis:

Pituitary: Pituitary adenoma, null cell type.

Microscopic Description:

Sections show multiple pieces of pituitary adenoma, associated with nasopharyngeal mucosa, and thin portions of bone. Extremely sparse cells are immunoreactive for ACTH. There is negative immunoreactivity for growth hormonr, prolactin, FSH, TSH and LH.