PMC4087301_01
Comparison between initial visual field testing and 3-month follow-up visual field testing. (a) Initial visual field test showing right eye inferotemporal visual field deficit. (b) Worsening of visual field deficit in right eye at 3-month follow-up visual field testing.
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The initial ophthalmological examination was consistent with a right inferotemporal visual field deficit (Figure 1(a)). Three months after her initial assessment, her visual symptoms worsened, with progression of the visual field deficit in the right eye (Figure 1(b)).
Comparison of MRI pituitary with and without contrast images between initial evaluation and follow-up evaluation. At the initial evaluation ((a) Sagittal slice; (b) and (c) Coronal slices), the pituitary infundibulum thickening was seen with minimal involvement of optic chiasm. At the follow-up evaluation 3 months later ((d) Sagittal slice; (e) and (f) Coronal Slices), abnormal enlargement and enhancement of infundibulum worsened with progressive involvement of left aspect of optic chiasm and proximal portion of left optic nerve.
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The initial MRI reported abnormal enhancement and 6.3 mm thickening of the infundibulum with involvement of the left aspect of the optic chiasm and proximal portion of the left optic nerve (Figures 2(a)-2(c)). Repeat MRI imaging of the pituitary reported progressive infiltration of the left optic nerve (Figures 2(d) and 2(e)).
Biopsy of infundibulum: (a) H&E sections of lesion show sheets of small lymphocytes and clusters of larger cells (orig. mag. 20x), (b) CD3 stain of entire biopsy shows predominance of T cells (DAB, orig. mag. 4x), (c) placental alkaline phosphatase (PLAP) immunostain demonstrates that at least some of larger cells are germ cell tumors, (d) keratin immunostain shows nests of epithelial cells consistent pituitary follicles (positive synaptophysin not shown) (DAB orig. mag. 10x), (e) keratin stains also show individual positive cells in area of germ cell tumor, suspicious for an embryonal carcinoma component (DAB, orig. mag. 20x), and (f) CD30 stains confirm presence of embryonal carcinoma component (DAB, orig. mag. 20x).
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Surgical pathological slides and immunohistochemical staining results are shown in Figure 3.