PMC4936984_01
The preoperative cranial CT scan showing a high-density mass in the suprasellar cistern with spot intratumoral calcification
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Fig1
Computed tomography scan showed a roundish homogenous and mildly high density mass in the sellar and suprasellar regions, with clear margin, intra-tumor calcification, but no periphery edema (Fig. 1).
The pre- and post-operative MRI. a-d Preoperative MRI showing a intrasellar and suprasellar tumor extending to anterior skull base and superior clivus. e, f The postoperative enhanced MRI showing subtotal tumor removal, with a little tumor remained in the intrasellar region
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Fig2
There were signals of slight hypointense on T1-weighted images (Fig. 2a), slight hyperintense on T2-weighted images (Fig. 2b), moderate nonhomogeneous enhancement (Fig. 2c, d) and the dural tail sign (Fig. 2d), All signals were with clear margin and without periphery edema (Fig. 2a-d). Cranial MRI showed subtotal tumor removal, with a little tumor remained in intrasellar region (Fig. 2e, f).
Intraoperative photograph. a-c The tumor being showed at the interspace I (a), interspace II (b), interspace III (c). d-f The tumors being resected in the interspace I (d), II (e), III (f)
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Fig3
A left transpterional craniotomy exposed the tumor, which was mainly located in suprasellar region and was partially extended into the intrasellar, anterior skull base, cavernous sinus and upper clivus (Fig. 3a-c). The bilateral optic nerves were compressed severely (Fig. 3a, b). The tumor was then separated along its pseudocapsular margin, and was resected in the interspace I, II, III, respectively (Fig. 3d-f). The bilateral optic nerves were decompressed well after tumor resection (Fig. 3d, e).
The HE staining and immunohistochemical staining. a (HE x 200) Oval well-differentiated tumor cell presenting schistic distribution, with neuropil structure observed in some region. b-d (Leica BOND-MAX automatic immunohistochemical staining machine x 200) The markers of NeuN (b) and Alpha-internexin (c) expressing strongly positive, and the Ki67 index being 3 % (d)
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Fig4
Neuropil structure was observed in some region of the tumor tissues, without necrosis (Fig. 4a). Immunohistochemical staining showed that the neuronal markers such as Synaptophysin, NeuN and Alpha-internexin were highly positive (Fig. 4b-c). The p53 albumen had no mutation. The Ki67 index was around 3 % (Fig. 4d).