Pituitary macroadenoma - invading the cavernous sinus

Case contributed by Dr Bruno Di Muzio

Presentation

Elevated prolactin levels (~45000H).

Patient Data

Age: 53-year-old
Gender: Male
MRI

Pituitary protocol

The sella is asymmetrically enlarged due to a pituitary solid mass that measures approximately 30 x 24 x 30 mm (longitudinal x anteroposterior x transverse), invades the cavernous sinus on the right, and extends to the suprasellar cistern abutting the optic chiasm superiorly.

No evidence of recent haemorrhage within it.

The tumour demonstrates small peripheral cystic components superiorly, diffusion restriction and vivid contrast enhancement. The neuro hypophysis is identified posterosuperiorly displaced to the left. The infundibulum is not identified. Sphenoid sinuses are clear.

The remainder of the imaged brain (please note this study has been targeted to the pituitary, and as such the whole brain has not been imaged) appears unremarkable.

Case Discussion

Typical radiographic features of a pituitary macroadenoma that invades the cavernous sinus. The extremely elevated levels of prolactinin makes a prolactinoma most likely. 

The diagnosis was achieved based on imaging and clinical data. 

Prolactin secreting tumours are most frequently responsible for cavernous sinus extension, and typically prolactin level increase significantly when the tumour gains access to the sinus. Once in the sinus, these tumours are difficult to completely resect. 

PlayAdd to Share

Case information

rID: 44117
Case created: 7th Apr 2016
Last edited: 7th Apr 2016
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.