Presentation
Headaches
Patient Data
Pituitary lesion has a solid left sided enhancing component which is greater than can be accounted for by normal pituitary tissue. The differential diagnosis is therefore between an adenoma with eccentric cystic component, or less likely a craniopharyngioma.
Meningioma with hyperostosis also noted.
Case Discussion
The patient went on to have surgery.
Histology
MICROSCOPIC DESCRIPTION
Pituitary: The sections show a moderately cellular pituitary adenoma comprising nests and perivascular pseudorosettes, surrounded by vascularized stroma. The tumor cells have mildly enlarged round nuclei, finely granular chromatin and moderate amounts of eosinophilic cytoplasm. There are no atypical features. Normal anterior pituitary gland tissue is present. The tumor cells are positive for FSH. Immunostains for the other pituitary hormones are negative. The Ki-67 index is about 2%.
Meningioma: Paraffin sections show a moderately hypercellular meningioma with a mixed syncytial and fibroblastic architecture. In addition, there are numerous hyalinised and calcified psammoma bodies. Tumor cells have uniform nuclear features. No mitotic figures are identified and there is no necrosis. No evidence of brain invasion is seen.
FINAL DIAGNOSIS:
- Silent gonadotroph pituitary adenoma
- Meningioma
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