Presentation
Chronic headache and not specified visual disturbance.
Patient Data
The pituitary fossa is enlarged by an heterogenous mass which shows to be predominantly hyperattenuating with some small cystic areas. There is contrast enhancement of its solid components and the lesions has a mild suprasellar extension that distorts the optic chiasm on the left. Remainder brain is unremarkable. Further evaluation with MRI is advised.
The pituitary fossa is expanded, measuring 23 mm in anterior to posterior diameter, filled by a heterogeneous enhancing solid tumor, and shows a small focus of hemorrhagic component in its superior and posterior aspect. There is a suprasellar component that distorts the optic chiasm and diaphragma sella on the left. The infundibulum is not individualized and probably is displaced superiorly by the suprasellar extension of the mass.
On both sides the tumor bulges into the cavernous sinuses, contacting the right carotid artery over approximately 180 degrees and the left carotid artery over approximately 130 degrees. The mass also extends/bulges superiorly into the sphenoid sinus on the right.
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.
Conclusion: Solid mass enlarging the pituitary fossa is in keeping with a macroadenoma.
Case Discussion
This case illustrates a sellar mass with imaging features suggesting a pituitary macroadenoma.
There is no histologic confirmation.
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