PMC6336579_01
Enhanced MRI of sellar region in 2009. MRI before radiosurgery showed T1 low signal nodular intensity (0.5 x 0.9 x 0.4 cm) with homogeneous nodular enhancement of posterior pituitary, and also presented an enlarged pituitary stalk.
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F1
Enhanced MRI of sella region showed lesions (0.5 x 0.9 x 0.4 cm) on posterior pituitary and enlarged pituitary stalk, but anterior pituitary, supra sella cistern, and adjacent skull were all normal on the MRI image (Fig. 1).
Head CT and MRI in 2015. A) Pre-operation CT showed soft tissue density shadow (1.6 x 1.3 cm) with irregular shape and well-defined margin in the sella region, and showed homogeneous enhancement. But encephalocoele, cisterns and skull bones had no abnormal signals on CT image. B) Post-operation CT showed the bone flap of the right frontal bone with scalp soft tissue swelling and accumulation of gas in surgical area. A mixture of air, edematous fluid, and hemorrhage were seen under the bone flap. Right frontal lobe was slightly compressed. There was intracranial air, thin layer of subdural edematous fluid in bilateral frontotemporal area and left side of falx cerebrum. C) MRI showed postoperative manifestation of the sella region. There were the diploe signal disorder and thickening dura around the right frontal bone. An enhanced 1 cm-diameter patch was in the fundus of the 3rd encephalocoele. Pituitary and pituitary stalk were thin.
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F2
Enhanced head computed tomography (CT) showed lesions (1.6 x 1.3 cm) in the sella region, and showed homogeneous enhancement, but no bony lesions (Fig. 2A). Post-operation CT (Fig. 2B) and MRI (Fig. 2C) showed no evident abnormalities.
Photograph of surgical specimen. A) Scattered Langerhans cells were seen, with eosinophils and lymphocytes (HE staining, x400). And the lymphohistiocytic infiltration was positive to Langerin (B), S-100 protein (C) and to CD1a (D), CD68 (E), and Ki-67 (F) antigen markers (x400).
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F3
Histologic examination of the surgical specimen showed eosinophils and lymphocytes infiltration (Fig. 3A). And the lymphohistiocytic infiltration was positive to Langerin (Fig. 3B), S-100 protein (Fig. 3C) and to CD1a (Fig. 3D), CD68 (Fig. 3E), and Ki-67 (Fig. 3F) antigen markers.
Enhanced MRI of sella region in 2016 (A) and 2017 (B). A) Enhanced MRI in 2016 showed bone flap of the right frontal bone with adjacent meninges thicking, and long T1 and T2 signal in bilateral centrum semiovale. Encephalocoele and cisterns showed no evident abnormalities. There was an enhanced nodule (0.8 cm) in the left hypothalamus. B) Enhanced MRI in 2017 showed enhanced nodule (1.4 cm) in the left hypothalamus and pituitary stalk thicking. Long T1 and T2 signal located in bilateral centrum semiovale. Encephalocoele and cisterns were normal.
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F4
And MRI of sella region on June 2016 showed enhanced nodular shadow (about 0.8 cm) on the left hypothalamus (Fig.4A). And in the latest MRI on May 2017, the nodular shadow became larger (about 1.4 cm) (Fig. 4B).