PMC6447399_01
Preoperative MRI, with contrast axial (
A
) and sagittal (
B
) sections demonstrating a contrast-enhanced clival tumor. MRI, magnetic resonance imaging.
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Contrast-enhanced magnetic resonance imaging (MRI) and CT scan showed a clival tumor with osteolysis and infiltration of the right cavernous sinus ( Figs. 1 and 2 ).
Preoperative three-dimensional CT with contrast showing the clival tumor extending laterally from the right cavernous sinus into the petrous apex. CT, computed tomography.
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Contrast-enhanced magnetic resonance imaging (MRI) and CT scan showed a clival tumor with osteolysis and infiltration of the right cavernous sinus ( Figs. 1 and 2 ).
Pathologic evaluation at x40 magnification. The histologic section demonstrated anisonucleosis, sheet-like proliferation, eosinophilic cytoplasm, and mitosis.
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The tumor was pathologically diagnosed as a pituitary adenoma by three different pathologists ( Fig. 3 ).
MRI 34 days after the first operation with a contrast sagittal section, demonstrating significant tumor growth. MRI, magnetic resonance imaging.
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MRI showed significant growth of the residual clival tumor ( Fig. 4 ) and pathological diagnosis, so the patient was taken for contrast-enhanced whole-body CT, which showed no evidence of tumor, including in the liver. ( Fig. 5 ).
Noncontrast whole-body CT imaging 1 day before the second operation did not reveal any mass, including in the liver. CT, computed tomography.
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MRI showed significant growth of the residual clival tumor ( Fig. 4 ) and pathological diagnosis, so the patient was taken for contrast-enhanced whole-body CT, which showed no evidence of tumor, including in the liver. ( Fig. 5 ).
Contrast-enhanced whole-body CT scanning after the second operation showed an enhanced liver mass. CT, computed tomography.
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Contrast-enhanced whole-body CT scanning was performed again 60 days after the first operation and it showed a new enhanced liver mass ( Fig. 6 ).
During immunostaining, the pathological specimen was AFP positive. AFP,
alpha
-fetoprotein.
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Immunostaining of the pathological specimen was positive for AFP ( Fig. 7 ).
CT immediately after the second operation (
A
) and one month after the second operation (
B
). CT, computed tomography.
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The residual tumor rapidly increased in size following the second surgery ( Fig. 8A and B ).