PMC7468188_01
Preoperative imaging (a) coronal T2-weighted magnetic resonance imaging (MRI) shows a hyperintense mass measuring 2.4 x 2.6 x 1.9 cm in the sellar and suprasellar region. (b) Coronal T1-weighted MRI shows a hyperintense mass with a hypointense, nonenhancing nodule. Postcontrast T1-weighted MRI in the axial (c) and sagittal (d) planes shows a heterogeneously enhancing mass.
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F1
T2 sequences with a nonenhancing, T1 hypointense nodule [Figure 1]. There was mass effect on the optic chiasm without extension into the cavernous sinus. The computed tomography scan did not show any calcifications [Figure 2].
Preoperative imaging noncontrast computed tomography image in sagittal (a) and axial (b) planes shows a sellar mass extending into the suprasellar region. No calcifications are seen in the lesion.
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F2
T2 sequences with a nonenhancing, T1 hypointense nodule [Figure 1]. There was mass effect on the optic chiasm without extension into the cavernous sinus. The computed tomography scan did not show any calcifications [Figure 2].
Intraoperative imaging intraoperative images of tumor texture and behavior, including (a) motor oil drainage, (b) thick, fibrous cystic capsule, (c) cholesterol granuloma, and (d) adhesion to the optic chiasm.
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F3
There were dense adhesions of the tumor capsule to bilateral optic nerves and chiasm [Figure 3].
Postoperative imaging postcontrast axial T1-weighted image in sagittal (a) and coronal (b) planes shows gross total resection of the tumor with decompression of the optic chiasm. The residual fat graft is noted in the inferior portion of the resection cavity (yellow star). The orange arrow in Figure 4a shows the placement of the Medpor graft, and the green arrow points to the layering of the pedicled nasoseptal flap for a multilayered closure.
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F4
The residual fat graft as well as the MEDPOR (Stryker) skull base reconstruction can also be visualized [Figure 4].
Beta-catenin stain beta-catenin immunostaining at x100 demonstrating dense fibrous walled cyst with squamous cells.
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F5
Hematoxylin and eosin staining hematoxylin and eosin staining at x4 (a), x20 (b), x100 (c), and x1000 (d) demonstrating marked degenerative changes, lymphocytic/histiocytic inflammation, hemosiderin pigment, cholesterol clefts, and multinucleate giant cells. (d) Orange arrow shows the ciliated epithelial cells.
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F6