Presentation
Collapse.
Patient Data
The pituitary fossa is expanded and shows a bony defect in its floor. A large mass occupies the remodeled sella and extends inferiorly into the sphenoid sinus and superiorly into the suprasellar cistern. A cystic focus is identified within the lesion.
The remainder of the brain is unremarkable.
The pituitary fossa is expanded with deficiency of its floor. A heterogeneous mass occupies the remodeled sella and extends inferiorly into the sphenoid sinus. The infundibulum is displaced posteriorly and toward the left. There is superior extension into the suprasellar cistern with elevation and compression of the optic chiasm and right optic nerve. No cavernous sinus extension.
Most of the mass has heterogeneous high T2 signal and is T1 isointense with vivid enhancement. However there also multiple cystic foci within the lesion, a few with intrinsic T1 hyperintensity. No large T2 hypointense component.
Conclusion: Sellar and suprasellar mass with optic chiasm and right optic nerve compression, but no cavernous sinus invasion. This is most likely to be pituitary macroadenoma.
MACROSCOPIC DESCRIPTION:
1. "Pituitary tumor": Tan and hemorrhagic nodule 14x7x7mm. Bisected longitudinally. FS/SMEAR DIAGNOSIS: Pituitary adenoma.
2. "Pituitary tumor": Two pieces of pink tissue 5-6mm.
MICROSCOPIC DESCRIPTION: 1-2. Sections show a hypercellular tumor composed of solid nests and trabeculae. Tumor cells contain abundant pale eosinophilic cytoplasm, oval nuclei with coarsely granular chromatin and small nucleoli. Infrequent mitoses are seen. No necrosis is identified. Focally the tumor cells infiltrate between bony trabeculae. The tumor incorporates several cystic spaces lined by a tall columnar epithelium, suggestive of the remnants of a Rathke's cleft cyst. Immunohistochemistry results show tumor cells stain positive for FSH whilst negative for Prolactin, GH, TSH, LH, ACTH and CAM 5.2. The Topoisomerase proliferation index is <1%.
DIAGNOSIS: 1-2. Pituitary tumor: Silent gonadotroph cell pituitary adenoma with bone invasion.
Case Discussion
Case of a pituitary macroadenoma with cystic components.
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