Pituitary fossa / sphenoid sinus metastasis

Case contributed by A.Prof Frank Gaillard

Presentation

No history available. Lets say galactorrhea for the sake of argument.

Patient Data

Age: 55 years
Gender: Female

CT brain

Modality: CT

A permeative pattern to the body the sphenoid bone shown, extending dorsally, and into the pituitary fossa. This is contiguous with a 2 cm mass filling the body of the sphenoid, with either calcified or ossified matrix. No other destructive lesion is shown. Ventricles and sulci within normal. Ossification of the falx is incidentally noted. The right mastoid air cells are opacified.

MRI brain

Modality: MRI

There is a heterogeneous non-expansive of mass centred on the floor of the pituitary fossa / superior clivus,extending into the posterior sphenoid sinus. The central portion of this mass within the sinus measures 21 x 13 mm in the sagittal plane. This is associated with diffuse pachymeningeal thickening in the prepontine cistern, up to 4 mm thick and extending into the dorsum sella. Normal pituitary tissue is elevated by the mass. 

There is in addition, unusually low signal in the marrow cavity of the skull vault, without enhancement. This is a non-specific feature which could represent red marrow regeneration.

In the cerebral parenchyma, there are numerous small T2 hyperintense fossa in the subcortical white matter of both cerebral hemispheres. This is more than would be expected age and could represent chronic microvascular ischaemia or gliosis. None of these lesions demonstrate enhancement or restricted diffusion. No vasogenic oedema is seen. The ventricles and sulci is normal in size of each. 

The mastoid cells are fluid filled. There is moderate erosion on the left mandibular condyle evidence of temporomandibular joint synovitis, consistent chronic degenerative joint disease.

Case Discussion

This patient had known metastatic breast cancer. This mass was biopsied and confirmed to be a metastasis and was treated with radiotherapy. 

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Case Information

rID: 17609
Case created: 29th Apr 2012
Last edited: 24th Dec 2016
Inclusion in quiz mode: Included

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