PMC8769389_01
Preoperative contrasted T1-weighted coronal and sagittal images demonstrate a heterogeneously enhanced suprasellar mass and the antero-superiorly displaced optic nerves (A, B). A three-dimensional computer graphic model for preoperative simulation is shown (C). Intraoperative picture shows the yellowish firm mass that has blood supplies from the capsular arteries (D). The mass was strongly adhered to the PCoA and the oculomotor nerve (III) (E). The PG was identified under the mass. The BA was exposed after removing a significant amount of the bulk (F). III: oculomotor nerve, BA: basilar artery, ON: optic nerve, PCoA: posterior communicating artery, PG: pituitary gland.
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F1
On magnetic resonance imaging (MRI), a heterogeneously enhanced suprasellar mass of 25 mm in diameter with peripheral calcification was detected (Figs. 1A and 1B). 18-Fluorodeoxyglucose-positron emission tomography showed an increased uptake in the joints of the extremities and bilateral tibia as well as suprasellar lesion. A three-dimensional reconstruction model was created based on the MRI and computed tomography for surgical simulation (Fig. 1C). Following arachnoid dissection, yellowish fibrous mass was exposed (Fig. 1D), which was very hard and loosely adhered to the diaphragm sellae. While the mass was not significantly vascularized, it tightly adhered to the optic chiasm, and involved the oculomotor nerves, the posterior cerebral arteries, and its perforators in the lateral aspects (Fig. 1E). Thus, we intentionally abstained from gross total resection, and achieved maximum mass reduction instead, for decompression of the optic chiasm (Fig. 1F).
The hematoxylin and eosin staining of the specimen shows lipid-laden histiocytes and Touton-like multinucleated giant cell (arrow, A; original magnification x 200). Immunohistochemical analysis reveals negativity with CD1a (B, original magnification x 400). Positivity with CD68 stains (C, original magnification x 400).
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F2
On immunohistochemical analysis, the histiocytes were CD68 positive, CD1a negative, and S100 negative (Fig. 2).
Postoperative contrasted T1-weighted image shows reasonable decompression of the mass (A). Contrasted T1-weighted image at 1 year demonstrates slow progression of the mass (B).
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F3
MRI on postoperative day 1 showed reasonable mass reduction (Fig. 3A). At the last follow-up, 1 year after the surgery, though MRI demonstrated mild intermittent regrowth of the residual mass, the patient remained clinically stable without steroid or interferon-alpha therapy (Fig. 3B).