PMC2718126_01
A 42-year-old male patient who presented with a two-month history of headache and a four-day history of diplopia.. A. T2-weighted axial MR image at the level of the sphenoid sinus shows very low heterogeneous signal intensity involving the clivus and bilateral cavernous sinuses, with sphenoid sinusitis (arrows). Note the narrowing of the cavernous part of the right internal carotid artery (arrowhead).. B. T2-weighted axial MR image at the level of the nasopharynx shows a high signal intensity lesion in the prevertebral muscles (arrowheads) and a heterogeneous mixed high and low signal intensity lesion in the clivus (arrows).. C. T2-weighted mid-sagittal MR image reveals an expansile heterogeneous low signal intensity lesion involving the entire clivus (arrows). Note the presence of an apparently normal pituitary gland and intact sellar floor.. D. T1-weighted mid-sagittal MR image at the same level as C shows mixed intermediate and low signal intensity replacing the entire clival bone marrow. The posterior line of the cortical dark signal has been destroyed (arrows).. E. Contrast-enhanced T1-weighted sagittal MR image at the same level as C demonstrates strong enhancement of the lesion (arrows), with small nonenhancing areas.. F. Contrast-enhanced T1-weighted coronal MR image at the level of the pituitary stalk shows bilateral involvement of the cavernous sinuses associated with narrowing of the cavernous portion of the right internal carotid artery due to infiltration of the lesion (arrows).. G. Coronal bone algorithm CT scan obtained at the level of the pituitary gland shows permeative bone destruction of the clivus (arrows).. H. Pathologic specimen obtained from the clivus shows thick fibrous bands with scattered chronic inflammatory cells (H&E staining, original magnification x100).
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T2-weighted MR imaging of the brain demonstrated replacement of the entire clival bone marrow and cavernous sinus by heterogeneous low signal intensity and small areas of high signal intensity, and there was evidence of sphenoid sinusitis (Figs. 1A-C). T2-weighted axial imaging (Fig. 1B), and the pituitary gland was normal in size and shape, with an intact cortical signal void of sellar floor. T1-weighted imaging of the lesion demonstrated mixed intermediate and low signal intensity (Fig. 1D), and at gadolinium-enhanced T1-weighted imaging, intense enhancement was observed (Fig. 1E). The bilateral cavernous sinuses were also involved by the lesion, with diffuse narrowing of the cavernous portion of the right internal carotid artery (Figs. 1A, F). After clival biopsy, a CT examination was performed : the images obtained depicted multifocal permeative bone destruction in the clivus (Fig. 1G) and a bulky retropharyngeal mass of soft tissue density. Biopsy specimens from the retropharyngeal soft tissue mass-like lesion showed bundles of fibroblasts admixed with inflammatory cells composed of lymphocytes and plasma cells (Fig. 1H).