Presentation
Hypogonadism and low libido.
Patient Data
A large heterogeneous enhancing solid mass has expanded the pituitary fossa and extends into the suprasellar cistern, touching the optic chiasm without displacement. On T2 images the diaphragma sella can be seen to be elevated.
The mass measures 2.3 x 2.2 x 1.9 cm in size. Remnant pituitary gland is located at the posterior superior aspect on the right side. No cavernous sinus extension or protrusion into the prepontine cistern is present. There is no hydrocephalus. Midline structures of the brain are normal.
The diaphragma sella can be seen to be elevated (yellow arrow) on the right, a clear sign that the mass grew in the fossa, and then went up into the suprasellar cistern.
Case Discussion
The patient went on to have a transphenoidal resection.
MICROSCOPIC DESCRIPTION:
Paraffin sections show fragments of a moderately hypercellular adenoma. Tumor cells have uniform round and oval hyperchromatic nuclei and a moderate amount of pale cytoplasm and are arranged in trabeculae and diffuse sheets in a vascular stroma. No mitotic figures or areas of necrosis are identified and no normal anterior pituitary tissue is included. No immunostaining for growth hormone, prolactin, ACTH, FSH or TSH is seen in tumor cells. Scattered groups of tumor cells show moderate staining for LH. The features are of null cell adenoma.
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