PMC3942612_01
Preoperative axial (a) coronal (b) and sagittal (c) MRI scans showing this case of a large intra and suprasellar mass compressing the optic chiasm and extending toward the diencephalon; postoperative axial (d) coronal (e) and sagittal (f) MRI scans demonstrating the near total removal of the lesion. The autologous fat (hyperintensity), used for reconstruction, fills the surgical cavity
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F1
Neuroradiological investigation, by means of magnetic resonance imaging (MRI) scans, demonstrated a large mass arising from the sella with a significant suprasellar component, compressing the optic chiasm and extending into the third ventricle, showing nonhomogeneous enhancement after intravenous contrast administration [Figure 1a-c]. One month postoperative MRI confirmed near-total tumor removal [Figure 1d-f].
(a) after opening the dura, the lesion comes into view splitting the pituitary gland in several parts; (b) initial intracapsular debulking of the tumor with the aid of the cavitron ultrasonic aspirator (CUSA); (c) fine dissection of the right side of the tumor capsule until the right optic nerve comes into view; (d) left optic nerve exposition T: tumor; PS: planum sphenoidale; DM: dura mater; ONR: right optic nerve; ONL: left optic nerve; Ps: pituitary stalk *: pituitary gland
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F2
Multiple fragments of tissue from different areas of the lesion were taken during operation in order to obtain an accurate hystopathological diagnosis [Figure 2].
(a) Removal of the suprasellar part of the tumor; (b) identification of the pituitary stalk leaving intentionally in place a little tumor fragment surrounding it and the infundibulum; (c) panoramic view; (d) close-up view of the floor of the third ventricle; (e) schematic picture showing the reconstruction technique used after the approach; (f) particular of the multilayer "sandwich" placed in the intradural space with the external coat fixed in the extradural surface T: tumor; Ps: pituitary stalk; CH: chiasm; ThV: third ventricle; MB: mammillary bodies; **: tuber cinereum
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F3
Mixed germ cell tumor: (a) germinoma pattern: large individual cells with abundant clear cytoplasm and a round nucleus, surrounded by small lymphocytes (H and E, x10) (g) high power view (H and E, x40); (b) embryonal carcinoma pattern: cohesive cells with a glandular pattern, showing a strong anaplasia and a big eosinophilic nucleolus (H and E, x10); positivity for PLAP (c) and c-Kit (e) in the germinoma component and for PLAP (d), CD30 (f) and CK7 (h) in the embryonal carcinoma component
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F4