Presentation
Elevated prolactin levels (~45000H).
Patient Data
The sella is asymmetrically enlarged due to a pituitary solid mass that measures approximately 30 x 24 x 30 mm (longitudinal x anteroposterior x transverse), invades the cavernous sinus on the right, and extends to the suprasellar cistern abutting the optic chiasm superiorly.
No evidence of recent hemorrhage within it.
The tumor demonstrates small peripheral cystic components superiorly, diffusion restriction and vivid contrast enhancement. The neuro hypophysis is identified posterosuperiorly displaced to the left. The infundibulum is not identified. Sphenoid sinuses are clear.
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.
Case Discussion
Typical radiographic features of a pituitary macroadenoma that invades the cavernous sinus. The extremely elevated levels of prolactinin makes a prolactinoma most likely.
The diagnosis was achieved based on imaging and clinical data.
Prolactin secreting tumors are most frequently responsible for cavernous sinus extension, and typically prolactin level increase significantly when the tumor gains access to the sinus. Once in the sinus, these tumors are difficult to completely resect.
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