PMC4960922_01
Magnetic resonance imaging from onset to surgery. Sagittal section of T1-weighted images on admission showed thickened pituitary and stalk extending toward the hypothalamus and no evidence of posterior lobe hyperintensity (a). Sagittal and coronal section of gadolinium-enhanced T1-weighted image (b and e) and coronal section of T2-weighted image (c) at the time of her visit showed the intrasellar and suprasellar multicystic lesion with heterogeneous contrast. Coronal section of gadolinium-enhanced T1-weighted image showed the lesion shrinking (f) after transient expanding on admission (e) compared to 1 month ago (d)
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F1
Magnetic resonance imaging (MRI) showed a thickened pituitary stalk with a multicystic lesion extending toward the hypothalamus and no evidence of posterior lobe hyperintensity on T1-weighted imaging [Figure 1a-c and e]. A series of MRI recorded during the following 2 months revealed a gradual decrease in the lesion size without diminishment [Figure 1d-f].
Intraoperative picture of the transsphenoidal and tuberculum sellae endoscopic surgery. Intraoperative findings revealed a soft yellowish cystic lesion ( ) along the pituitary stalk ( ) and the optic chiasma (Delta)
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F2
Endoscopic exploration clearly displayed a soft yellowish lesion along with the pituitary stalk [Figure 2], and subtotal resection was performed.
Pathological findings of the lesion. The cystic lesion was histologically characterized by infiltration of the anterior pituitary by foamy histiocytes, plasma cells, and lymphocytes (a, x200). The foamy cells were immunopositive for the macrophage marker CD68 (b, x200) and immunonegative for CD1a (c, x200) and S-100 protein (d, x200). The majority of lymphocytes are immunopositive for CD3 (e, x200). There was no evidence of pituitary adenoma or granuloma or necrosis
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F3
The infiltrating foamy cells were immunopositive for the macrophage marker CD68 and were immunonegative for CD1a and S-100 protein [Figure 3].
Magnetic resonance imaging after surgery. The postoperative series of magnetic resonance imaging 1 year after the surgery showed no progression of the lesion
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F4
Postoperative MRI showed no progression of the lesion [Figure 4].