PMC8769468_01
Head MR reveals a clival tumor extending to the paranasal sinuses and left nasal cavity. The lesion appears as an isointense area on T1-weighted imaging (A), an iso- to high-intensity area on T2-weighted imaging (B), and homogeneous enhancement on T1-weighted imaging with gadolinium contrast (C: axial, D: coronal, E: sagittal).
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F1
MRI depicted the tumor as an isointense area on T1-weighted sequences (Fig. 1A), an iso- to high-intensity area on T2-weighted sequences (Fig. 1B), and a homogeneously enhanced area with gadolinium contrast (Fig. 1C-E).
Axial skull CT shows that the tumor extends from the clivus to the ethmoidal sinuses and posterior nasal aperture, and that it erodes the sphenoid bone.
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F2
CT revealed that the tumor extended from the clivus to the ethmoidal sinuses and posterior nasal aperture, and that it eroded the sphenoid bone (Fig. 2).
Histological examination of the tumor cells reveals oval atypical cells with uniform nuclei and scant cytoplasm arranged in sheets or a lobular pattern (A: x100 and B: x400, hematoxylin and eosin stain). The tumor cells are immunohistochemically positive for synaptophysin (C: x400) and chromogranin A (D: x400), and demonstrate weak, patchy expression of ACTH (E: x400). Electron microscopy reveals the presence of scattered cytoplasmic neuroendocrine granules (F: bar = 2.0 mum). ACTH: adrenocorticotropic hormone.
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F3
Histological examination revealed that the tumor was composed of oval atypical cells with uniform nuclei and scant cytoplasm arranged in sheets or a lobular pattern (Fig. 3A and 3B). The specimen was immunohistochemically positive for cytokeratins AE1/AE3, which are epithelial markers, and for synaptophysin (Fig. 3C), chromogranin A (Fig. 3D), and CD56, which are neuroendocrine markers. Electron microscopy revealed the presence of scattered cytoplasmic neuroendocrine granules (Fig. 3F).
Axial head CT reveals massive pneumocephalus around the basal cistern (A-C). CT reveals that clival tumor shrinkage and a little air intrusion into the interpeduncular cistern (D, E).
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F4
Two months later, she required transportation to the hospital due to disturbed consciousness, and CT revealed massive pneumocephalus around the basal cistern (Fig. 4A-C). The clival tumor had shrunk and a little air had entered the interpeduncular cistern (Fig. 4D and 4E).