PMC3922192_01
2006 MRI pituitary: (a) coronal T2WI, (b) coronal T1WI and (c) sagittal T1WI respectively.
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MRI of the pituitary (Fig. 1) revealed a 1.5 cm mass lifting and thinning the optic chiasm with irregular signal intensity on T1 and mixed intermediate and low T2 signal.
(Panels a-d) Histopathology of pituitary metastasis at diagnosis: (a) pituitary metastasis biopsy displaying well-formed papillae and cystic change (H&E 40x original magnification); (b) nuclear features of papillary thyroid carcinoma are present including some nuclear overlapping, nuclear grooves and 'dusty' chromatin (H&E 400x original magnification); (c) strong and diffuse reactivity for thyroglobulin (400x original magnification); and (d) diffuse nuclear reactivity for thyroid transcription factor-1 (400x original magnification). (Panels e-f) Histopathology of recurrence in pituitary metastasis 4 years later: (e) it is showing less well-developed architecture with cribriform and follicular patterns (H&E 40x original magnification) and (f) it is showing marked variation in nuclear size, hyperchromasia and membrane irregularities (H&E 400x original magnification).
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Histopathology and immunohistochemistry confirmed metastatic papillary thyroid carcinoma of the pituitary gland (Fig. 2A). She underwent a third transsphenoidal debulking of her pituitary metastases, which showed an increase in tumour grading (Fig. 2B).
2008 MRI pituitary: (a) coronal T2WI, (b) coronal T1WI and (c) sagittal T1WI respectively.
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Repeat MRI scan of the pituitary (Fig. 3) demonstrated a large 26x30x24 mm contrast enhancing mass with an irregular border centred within the pituitary fossa and extending into the sphenoid sinus and superiorly to abut and displace the optic chiasm.
2011 MRI pituitary: (a) coronal T2WI, (b) coronal T1WI and (c) sagittal T1WI respectively.
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She failed to achieve an adequate response from her radiotherapy, and over the next 3 years, the pituitary metastasis increased in its supra-sellar extent (Fig. 4).