Sellar/suprasellar pituitary macroadenoma

Case contributed by Amr Farouk


63 years old male patient presented with headache & visual disturbances of 1 year duration.

Patient Data

Age: 63-year-old
Gender: Male

MRI Brain (pituitary protocol)


A large well defined oblong lobulated sellar & suprasellar pituitary mass lesion. It appears of intermediate signal on T1 and T2 weighted images, with sizable areas of breaking down (of dark T1 and bright T2 signal) at its upper aspect. In post contrast study, its solid component shows intense homogeneous enhancement

The lesion shows the following relations and extensions:

  • Superiorly: It is seen effacing the suprasellar cistern and indenting the optic chiasm more on the left with more cranial extension, indenting the floor of 3rd ventricle.
  • Anteriorly: The lesion causes scalloping of the posterior wall of the sphenoid sinus.
  • Posteriorly: It is seen indenting inter-peduncular cistern smoothly.
  • Widening and ballooning of the sellar cavity is noted with more right infra-sellar extension, encroaching on the sphenoid sinus.
  • No para-sellar extension.
  • Both cavernous sinuses are seen indented along their inner aspects by the mass (more on the right), with patent signal void intra-cavernous carotid arteries.

Sub-cortical and periventricular white matter sheets and areas of high T2 and FLAIR signal are seen.

Multiple foci of high T2 signal are seen at both frontoparietal and basal ganglia regions. They are neither surrounded by edema nor exerting mass effect.  Few similar pontine foci are also seen.

Mildly dilated ventricular system, with no mass effect or midline shift.

Prominent cerebral cortical sulci and extra-axial C.S.F. spaces.

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