Pituitary macroadenoma

Case contributed by A.Prof Frank Gaillard

Presentation

Loss of peripheral vision.

Patient Data

Age: 45 years
Gender: Female
CT

The mildly hyperdense smoothly lobulated sellar/suprasellar mass measures 25 x 22 x 14 mm and demonstrates vivid contrast enhancement.  Paranasal sinuses and ostiomeatal units are clear, with accessory anterior (Agger nasi) ethmoid air cells, left concha bullosa, relatively large septate sphenoid sinus and rightward nasal septal deviation noted. 

Sagittal midline bone window image demonstrates smooth enlargement of the pituitary fossa. 

Annotated image

Pituitary region mass (blue dotted line) is closely apposed to the left internal carotid artery (red arrow) and has similar density on post contrast images. 

Sagittal reconstruction demonstrates the expanded pituitary fossa ( * ) and despite bone window the mass extending into the suprasellar cistern is faintly discernible (yellow dotted line). 

MRI

The pituitary fossa is enlarged by a well circumscribed enhancing ovoid mass  measuring 16 x 25 x 22 mm.  The diaphragma sella is elevated and widely spread (diaphragmatic hiatus is approximately 2 cm wide). The optic chiasm is markedly elevated and thinned by the suprasellar component of the mass, and the A1/Acom/A2 complex is in close apposition to the superior surface of the mass, also elevated. There is no evidence of cavernous sinus involvement, and flow voids in the internal carotid arteries are unremarkable in appearance and location. 

The patient went on to have a transsphenoidal hypophysectomy and resection. 

Histology

MICROSCOPIC DESCRIPTION: The sections show a moderately cellular pituitary adenoma comprising nests, surrounded by vascularised stroma. The tumour cells have mildly enlarged round nuclei, finely granular chromatin and moderate amounts of eosinophilic cytoplasm.  There are no atypical features. Very small amount of normal anterior pituitary gland tissue is present in specimen 3. The tumour cells are positive for FSH and SF-1. The Ki-67 index is about 2%. Immunostains for prolactin, TSH, LH, ACTH and GH are negative.

FINAL DIAGNOSIS: Silent gonadotroph adenoma.

Case Discussion

Typical appearances of a pituitary macroadenoma.

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Case information

rID: 19439
Case created: 9th Sep 2012
Last edited: 30th Aug 2017
Inclusion in quiz mode: Included

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