PMC5569396_01
(a) Pre-operative magnetic resonance imaging (MRI) with gadolinium. T1-weighted coronal section showing a large enhancing sellar lesion with suprasellar extension, impinging the chiasm and abutting both cavernous sinuses. (b) T1-weighted sagittal section with gadolinium showing a mixed solid-cystic component of the tumor. The chiasm is dislocated upwards (c) T2-weighted coronal scan showing a mixed solid-cystic components of the lesion
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F1
(a and b) CT scan performed after sudden clinical deterioration showed no clear intra- or extr-axial bleeding or fluid collection. No ischemia could be detected. (c) The lesion of the sella had eroded the skull base
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F2
After an emergency CT showed no parenchymal infarction, extra-axial bleeding, fluid collection, or ischemia [Figure 2], an urgent craniotomy was performed.
(a and b) Intra-operative pictures, right fronto-temporal craniotomy: The brain was swelling, with evident pus in the sulci and on the brain surface
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F3
After opening the dura mater, the brain was swelling, with a considerable amount of dense pus covering the brain surface [Figure 3a and b].
Intra-operative picture: Inside the sellar lesion, more pus was found and drained
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F4
More purulent material was found within the tumor located in the sella and drained [Figure 4].
(a) Haematoxilin-eosin stained section of the adenoma at 4x magnification showing neoplastic cells admixed with a robust inflammatory infiltrate with neutrophils. (b) The same section at 10x magnification. (c) Synaptophysin positive immunostained section(4x)
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F5
The pathological analysis of the intraoperative material confirmed a nonfunctioning pituitary adenoma with chronic inflammation and necrosis [Figure 5a-c].