Presentation
Six-month history of progressive visual changes, now has bitemporal hemianopia.
Patient Data
Mixed solid and cystic mass in the pituitary fossa extending into the suprasellar region, measuring 17 x 17 x 27 mm. No calcification. This exerts a mass effect on the optic chiasm. The Sella turcica is remodeled and expanded.
Bilobed (snowman) sella/suprasellar mixed solid and cystic mass with the cystic portion lying at the superior aspect of the tumor. The infundibulum is compressed by the suprasellar component. The solid component demonstrates vivid, homogeneous contrast enhancement. Enlargement and remodeling of the pituitary fossa. The anterior cerebral arteries (A1) are superiorly displaced and stretched. The optic chiasm is also superiorly displaced and compressed from its undersurface. Possible invasion of the right cavernous sinus. The left cavernous sinus is uninvolved.
Conclusion: solid/cystic sella/suprasellar lesion, favored to reflect a partially cystic pituitary macroadenoma. A craniopharyngioma is thought to be much less likely.
Case Discussion
The patient went on to have a biopsy.
Histology
Sections show fragments of tissue, which consists of a monotonous population of epithelioid cells. The cells have round nuclei with a stipple chromatin pattern with minimal nuclear pleomorphism. Mitotic figures are not conspicuous. No significant anaplasia is seen. The cells have a moderate amount of eosinophilic cytoplasm. Immunohistochemistry shows no staining with growth hormones, LH, TSH, APTH, and FSH. Prolactin shows focal staining of less than 1%. Ki67 is less than 1%.
DIAGNOSIS:
Brain tissue: pituitary adenoma; null cell type.
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