PMC10310352_01
Initial preoperative images. A: Plain CT image, sagittal view. B: T2-weighted MR image, coronal view. C: Gadolinium-enhanced T1-weighted MR image, sagittal view. D: Gadolinium-enhanced T1-weighted MR image, coronal view. These images (A-D) show a pituitary tumor with a maximum diameter of 16 mm in the sella compressing the optic chiasm and a 2-mm-diameter cystic lesion at the pituitary stalk, which demonstrates calcification on CT.
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Preoperative MRI showed a pituitary tumor with a maximum diameter of 16 mm in the sella compressing the optic chiasm and a 2-mm-diameter cystic lesion at the pituitary stalk, which demonstrated calcification on CT (Fig. 1A-D).
Initial postoperative, second preoperative, and postoperative images. A-C: Gadolinium-enhanced T1-weighted MR image, coronal view. D-F: Gadolinium-enhanced T1-weighted MR image, sagittal view. Initial postoperative images (A, D) show a small residual pituitary adenoma in the right cavernous sinus medial wall, and the cystic lesion is unchanged. Second preoperative images (B, E) show the cystic components with a 9-mm diameter in the pituitary stalk, and the residual tumor in the sella is enlarged compared to the size after the initial surgery. Second postoperative images (C, F) show no obvious residual tumor both the intrasellar and pituitary stalk lesions and preservation of the pituitary stalk.
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Postoperative MRI revealed a small residual pituitary adenoma in the medial wall of the right cavernous sinus, and the cystic lesion remained unchanged (Fig. 2A, D). After treatment for Graves' disease, the residual intrasellar tumor and pituitary stalk lesion gradually continued to increase in size (Fig. 2B, E). MRI showed cystic components with a 9-mm diameter in the pituitary stalk, and the residual tumor in the sella was enlarged compared to the size after the initial surgery (Fig. 2B, E). Postoperative MRI revealed no obvious residual tumor in either the intrasellar or pituitary stalk lesions or preservation of the pituitary stalk (Fig. 2C, F).
Immunohistochemistry of tumor samples from the first operation.
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Hematoxylin and eosin staining (A) showed tumor cells with relatively small, uniform round nuclei, and acidophilic cytoplasm growing in foci or sheets, and the stroma showed increased fibrous tissue rich in blood vessels. Positive staining for FSH (B), SF-1 (C), TSH (D), and Pit-1 (E, F) showed a small area of TSH-positive cells compared to that in the FSH-positive group. SF-1 was positive, consistent with the FSH-positive cell population, and Pit-1 was positive, consistent with the TSH-positive cell population. Scale bar of A = 100 mum and B, C, D, E = 2000 mum, where F is the enlargement of the area squared in E.
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The histopathological diagnosis of the intrasellar tumor was a clinically determined nonfunctioning FSH-positive pituitary adenoma (Fig. 3A). TSH-positive area, which was also Pit-1-positive, and an FSH-positive area, which was SF1-positive (Fig. 3B-F).
Immunohistochemistry of tumor samples from the second operation.
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Hematoxylin and eosin staining of the residual tumor within the sella (A) showed foci or sheets of cells with acidophilic sporangia with round nuclei and abundant vascular components in the stroma. Immunostaining showed different groups of FSH- (B) and TSH-positive cells (E), and each group of cells was positive for SF-1 (C) and Pit1 (F, G), respectively. There were some areas of mixed FSH- and TSH-positive cells, but immunostaining for other anterior pituitary hormones was negative, signifying a borderline area between FSH- and TSH-producing adenoma rather than normal anterior lobe tissue. Hematoxylin and eosin staining of the pituitary stalk lesion (D) showed that the tissue was composed of basal cells showing a fenestrated arrangement, stellate network, stratified squamous-like cells, and wet keratin. Scale bar of A, D = 200 mum, and B, C, E, F = 1 mm, where G is the enlargement of the area squared in F.
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TSH-positive cells, which were immunohistochemically positive for SF-1 and Pit-1, respectively (Fig. 4A-C, E-G). The immunostaining images of SF-1 and Pit-1 showed that different cells were stained (Fig. 4C, F, G). The cystic lesion in the pituitary stalk was diagnosed as adamantinomatous-type craniopharyngioma (Fig. 4D).