Pituitary adenoma - involving clivus
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MRI centered on the pituitary demonstrates a large mass which involves the clivus, pituitary fossa and extends both anteriorly into the sphenoid sinus and superiorly into the suprasellar cistern, elevating and distorting the chiasm and floor of the third ventricle. No normal pituitary can be identified.
It is isodense on T1 with moderate heterogeneous enhancement. Many small areas of high T2 signal as scattered throughout the mass.
Although the appearances are most consistent with a pituitary macroadenoma, given the high T2 signal the possibility of this mass representing a chordoma was entertained.
The patient went on to have a resection.
Sections show multiple pieces of pituitary adenoma, associated with nasopharyngeal mucosa, and thin portions of bone. Extremely sparse cells are immunoreactive for ACTH. There is negative immunoreactivity for growth hormone, prolactin, FSH, TSH and LH.
Final diagnosis: Pituitary adenoma, null cell type.