Presentation
Patient with a 4-month history of bilateral visual impairment, currently leading to blindness in the left eye, along with elevated serum prolactin levels.
Patient Data
Magnetic resonance imaging was performed using a 3-tesla machine, with T1 SPACE, T2, HEMO, and T1 sequences with intravenous gadolinium contrast.
The sellar region shows a central ovoid-shaped, well-defined, space-occupying lesion, heterogeneous in nature, isointense to gray matter on T1 and hyperintense on T2, with areas of magnetic susceptibility on HEMO sequences consistent with hemosiderin deposits. It demonstrates avid heterogeneous enhancement in the contrast phase, measuring 29 x 31 x 50 mm in its transverse, anteroposterior, and dorsoventral axes, respectively; compatible with a pituitary macroadenoma, there is diffuse destruction and invasion of the sphenoid sinus.
In the sagittal plane, the margin of the sellar lesion can be observed with the snowman sign, which refers to the configuration of many pituitary macroadenomas. This feature helps in differentiating these tumors from meningiomas extending into the pituitary fossa.
Case Discussion
Pituitary macroadenoma, Knosp grade 2 and Hardy-Vezina classification 4c. Superiorly, it occupies the suprasellar cistern, obliterating the anterior recesses of the third ventricle, and compressing the optic chiasm and infundibulum. Inferiorly, there is diffuse destruction and invasion of the sphenoid sinus. Laterally, it invades the cavernous sinus up to the lateral tangent line without surpassing it.
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