Presentation
Chronic intermittent headache with the blurring of vision for 1 year.
Patient Data
A large pituitary region mass is present that filling and enlarged fossa and extending above it.
The mass is predominantly isointense to cerebral parenchyma on T1 and T2 weighted imaging and heterogeneously contrast-enhancing.
It extends into sphenoid sinuses, and the suprasellar cistern, compressing the optic nerves and displacing superiorly the left aspect of the optic chiasm and surrounds the right cavernous carotid within the cavernous sinus without cavernous carotid narrowing. Invasion to the right Meckel's cave and pressure effect on the medial aspect of the right temporal lobe also is seen.
Extension and close contact with the left ICA cavernosal segment also is seen.
Case Discussion
MRI demonstrating features consistent with a pituitary macroadenoma.
The patient went on to have a resection.
Histology
Sections revealed sheets of tumor cells with a rather uniform round to oval nuclei without mitosis or atypia separated by the thin sinusoidal vascular network within foci of hemorrhage. No necrosis. Ki67 proliferative index is low(about 1%).
Final diagnosis: pituitary macroadenoma.