Presentation
Past history of head and neck squamous cell carcinoma.
Patient Data
A large suprasellar vividly enhancing mass arises in the suprasellar cistern, inseparable from the infundibulum. The anterior pituitary seems separate. It compresses the optic chiasm and splays the optic nerves. T2 hyperintensity within the optical tracts compatible with oedema.
Differential includes papillary craniopharyngioma, pituitary macroadenoma, lymphoma, metastasis and pituicytoma.
Case Discussion
The patient went on to have a resection.
Histology
The tumour forms nests and vague perivascular pseudorosette-like structures. The tumour cells are bland with oval nuclei, vesicular chromatin, occasional small nucleoli and amphophilic cytoplasm with poorly defined cell outlines. Occasional cells have nuclear grooves or intranuclear pseudo inclusions. There are no mitoses and no necrosis.
IMMUNOHISTOCHEMISTRY:
- The tumour cells are positive for S100 and TTF1.
- GFAP is focal and weak.
- The tumour cells are negative for ACTH, prolactin, FSH, TSH, LH, growth hormone, PLAP, synaptophysin and AE1/AE3.
- Ki67 is approximately 2-3%.
FINAL DIAGNOSIS: pituicytoma (WHO grade I).
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