PMC7265469_01
Goldmann perimetry field examination on admission demonstrating a slight visual disturbance (A) Preoperative (B) axial and (C) sagittal computed tomography (CT) shows a high attenuated mass in the sellar region with granular-like high density dots (white arrow) accompanied by expansion of the sella turcica.
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F1
A 42-year-old woman presented to our department with slight visual deterioration [Figure 1a]. Intracranial computed tomography (CT) showed a high-attenuated mass, including granular-like dots in the sellar and suprasellar regions, accompanied by an expansion of the sella turcica [Figure 1b and c].
On preoperative axial T2-weighted (A), T1-weighted (B), and gadolinium (Gd)-enhanced T1-weighted (C) magnetic resonance imaging (MRI), a tumor mass is seen in the sellar region extending into the suprasellar region. The tumor is homogeneously enhanced to a moderate degree with Gd. The enhanced anterior pituitary gland is displaced anteriorly (white arrow), and hyperintense on T1WI which suggested posteriorpituitary is appeared. The tumor is low intensity inside the solid mass on T2-weighted imaging (WI) (white dashed arrow).
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F2
T2-WI, and homogeneously enhanced to a moderate degree with gadolinium (Gd). The tumor extended into the suprasellar region, compressing the optic chiasm. The Gd-enhanced anterior pituitary gland was displaced supra-anteriorly, and high intensity on T1-WI suggested that the posterior pituitary appeared [Figure 2a-c].
A) Intraoperative findings from endoscopic, endonasal, transsphenoidal surgery (PG: pituitary anterior gland; T: tumor). Macroscopic examination of this tumor shows that it is solid and rubbery-firm. The cut surface is yellowish, and uncountable gray to yellow granules are appear to be inside the solid mass. The tumor has infiltrated into the posterior pituitary; therefore, subtotal resection is performed. Postoperative (B-1) sagittal and (B-2) coronal images of Gd-enhanced MRI one year after surgical resection show no signs of recurrence
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F3
Intraoperative findings demonstrated that this tumor was solid and extremely firm, including myriad yellowish granules without bleeding [Figure 3a and b]. The tumor originated from the posterior pituitary gland and had a clear margin between it and the anterior pituitary gland [Figure 3c]. Subtotal resection was achieved to reduce compression of the optic nerve [Figure 3d]. Taking all these results into account, the final diagnosis was GCT of the sellar region, belonging to tumors of the posterior pituitary in accordance with the WHO classification of central nervous system (CNS) tumors (2016). The patient remained clinically stable with a normal visual field, the residual tumor showed no enlargement at the next 1-year follow-up visit [Figure 3b], and the hormonal dysfunction (hyperprolactinemia) improved to near-normal levels (prolactin: 15.5 ng/ml).
Histopathology of the resected tumor shows round or polygonal cells with abundant granular eosinophilic cytoplasm and perivascular lymphocytic aggregates. Most nuclei are round to oval in appearance without evidence of cellular atypia and mitotic figures (hematoxylin and e osin staining) (a, b). Periodic acid S chiff (PAS) staining of cytoplasmic granules is resistant to diastase digestion (c: PAS staining, d: diastaseresistant-positive PAS reaction). Magnification, a) x100; b-d) x400. Scale bar, a) 400 mum, b-d) 100 mum.
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F4
In addition, perivascular lymphocytic aggregates were recognized [Figure 4a and b]. Periodic acid-Schiff (PAS) staining of cytoplasmic granules was resistant to diastase digestion [Figure 4c and d].
Photomicrographs showing the histopathology of the tumor. Most tumor cells are immunoreactive for S-100 protein (a), but immune-negative for glial fibrillary acidic protein (GFAP) (b). This tumor shows slightly positive staining for Ki-67 (MIB-1) (MIB-1 labeling index: 2.0%) (c). In addition, almost all tumor cells are strongly positive for TTF-1 (d). Magnification, a, b, d) x400; c) x100. Scale bar, a, b, d) 400 mum, c) 100 mum.
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F5
Tumor cells were immunoreactive for S-100 protein, but negative for GFAP [Figure 5a and b]. The Ki-67 (MIB-1) proliferation-related labeling index was low, at 2.0% [Figure 5c]. TTF-1 [Figure 5d].