Presentation
Decreased vision and right CN III palsy.
Patient Data
There is a heterogenous predominantly T1 isointense suprasellar mass that encases/narrows the cavernous segment of the right internal carotid artery. The optic chiasm is draped over the mass, with mild compression of the optic chiasm and adjoining right optic nerve. The mass enhances vividly in a heterogeneous fashion on dynamic sequences.
Case Discussion
The patient went on to have a transsphenoidal resection.
Histology
MICROSCOPIC DESCRIPTION: The sections show features of metastatic poorly differentiated carcinoma. The tumor forms trabeculae and nests. No glandular structures are noted. The tumor cells have enlarged pleomorphic nuclei, prominent nucleoli and small amounts of cytoplasm. No evidence of lymphovascular invasion is seen. There is no normal anterior pituitary tissue included.
- Estrogen receptor: Negative
- Progesterone receptor: Negative
- HER-2: Positive (3+)
- Previous positive SISH noted
FINAL DIAGNOSIS:
Pituitary metastasis: poorly differentiated adenocarcinoma, consistent with breast primary.
Discussion
At best, the only good clue that this lesion may be a metastasis rather than a far more common macroadenoma is the lack of pituitary fossa enlargement and slight 'fuzziness' to the masses outline.
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