Presentation
Morning headaches.
Patient Data
Centered on the pituitary fossa is a large, vividly enhancing mass. It appears extradural and is, at least, in contact with both internal carotid arteries and cavernous sinuses as well as the basilar artery. The mass erodes through the anterior cranial fossa floor, extending into the sphenoid sinus. Pituitary infundibulum is nodular and enhancing.
No intra- or extra-axial collection or hemorrhage demonstrated. Grey-white differentiation is preserved. Cerebral volume loss, in particular affecting the frontal and temporal lobes. Ventricular size and basal cisterns all appear normal. No other bony abnormality demonstrated.
Case Discussion
This patient has known metastatic non-small cell lung cancer (NSCLC) with numerous systemic metastases. A prior CT brain form >1 year ago had a normal pituitary fossa.
The differential in this instance is therefore between a metastasis centered in the pituitary fossa, perhaps of the pituitary itself given the changes to the infundibulum or a macroadenoma. Although the latter could have this appearance, in this clinical setting, especially in the presence of destruction of the pituitary fossa (rather than remodeling) and of a prior normal CT brain a metastasis is though far more likely.
The patient has been palliated and as such no histology or further imaging was obtained.
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