PMC6215971_01
Goldmann's perimeter test. Left amaurotic eye (Left) and right temporal hemianopia (right) (Octopus 900 Haag Streit Inc., Bern, Switzerland).
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Preoperative Brain Magnetic Resonance-Imaging (MRI) and Computed tomography-scan (CT-scan). Axials (A) T1 + Gadolinium, (B) T2-weighted, (C) Gradient echo sequence with a large poli-cystic enhancing selar lesion with extensive osteophytic reaction and invasion of the ipsilateral orbital apex associated with fibrous dysplasia and an enhancing selar mass lesion with their respectively Calcium intensities (white arrows). CT-scans (D) axial CT-scan showing the calcified pituitary gland (white arrow) and (E) coronal on bone density revealing thickness of the diploe on the right sphenoid wing (white arrow heads) and osteolytic lesion on the left orbital apex (black asterisk). (F and G) axial and coronal 3D bone reconstruction showing calcified pituitary gland (red arrows) and a calcified rim around the tumor.
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On brain Magnetic Resonance-Imaging (MRI) (Siemens 3.0 T magnetic resonance scanner and a 32-channel head coil) revealed a large policystic selar lesion with extensive osteophytic reaction and invasion of the ipsilateral orbital apex associated with fibrous dysplasia (see Fig. 2A and B) with a T2-weighted hypointense and enhancing selar mass lesion with Calcium intensity on the Gradient echo sequences (GRE) (Fig. 2C). Also the skull CT-scan (Siemens SOMATOM Sensation 64-slices) revealed an osteolytic lesion on the right orbital apex with thickness of the diploe (Fig. 2E) and pituitary gland with a calcified rim around the tumor (Fig. 2D, F and G).
CT-scan. Axial slides (A - C) after tumor resection and post operative changes.
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A second surgical resection was performed in 2016 by a left orbitozygomatic approach for tumor removal with no acute complications (Fig. 3A-C).
Gross aspect of the tumor (A) with outer greyish surface and thickened "like-capsule" (blue arrows) and (B) yellowish dystrophic calcifications alternating with areas of hemorrhage (white asterisk). Histological tumor features in (H&Ex400) (C) and (E) dystrophic calcifications of varying sizes and shapes. Immunohistochemical staining was positive for (F) growth hormone and (G). Histological basal ganglia features in (H&Ex800) (D) multiple calcifications on basal ganglia, (H) hypothalamus adjacent to the tumor, (I) brain tissue with fibrine inside vessel and (J) tortuous vessels con fine walls calcifications.
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Neuropathologic examination of the pituitary lesion removed in 2016 (first neuropathology report was unavailable) was characterized macroscopically by a 40 x 40 mm mass with grayish outer surface and inner yellowish-irregular zones thickened by "sand-like" calcifications (Fig. 4A and B). Histologically micro-hemorrhage with ossification areas within a thick pseudocapsule and multiple calcifications with a diffuse desmoplastic stromal component even within blood vessels were observed (Fig. 4C and D). Immunohistochemistry stains were positive for Growth Hormone and osteoconine (Fig. 4F-G). Brain autopsy showed perivascular granular-dystrophic calcifications in thalamus, hypothalamus and basal ganglia (Fig. 4D, H-J).