PMC9609953_01
MRI showing PM and. (a-d) Preoperative coronal and sagittal T1 MRI with and without contrast showing a lesion in the pituitary stalk and gland. There is mild splaying of the optic chiasm with lateral displacement of the left optic nerve. (e and f) A residual tumor involving the stalk and hypothalamus was identified on postoperative coronal and sagittal T1 MRI with contrast. (g and h) A follow-up MRI of the brain and cervical spine with contrast showed a leptomeningeal metastatic disease. (i) A follow-up MRI of the brain with contrast showing hydrocephalus due to leptomeningeal disease. A palliative ventriculoperitoneal shunt was placed.
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F1
A magnetic resonance image (MRI) demonstrated a 1.6 x 1.7 x 2.5 cm lesion on the pituitary stalk [Figures 1a-f]. While her residual tumor involving the stalk and hypothalamus had diminished in size, multiple intracranial areas of abnormal enhancement involving the cerebellum, brainstem, and supratentorial sulci were present [Figure 1g]. Leptomeningeal metastases were also seen in the spinal cord [Figure 1h]. April 2021, she was diagnosed with hydrocephalus [Figure 1i]. A palliative ventriculoperitoneal shunt was placed, but she succumbed to the disease in May 2021.
Histological appraisal of PM. (a) Hematoxylin and eosin stained section demonstrating neoplastic cells with anaplastic nuclei, prominent nucleoli, and mitotic activity. (b) Cytokeratin 7 immunohistochemically stained section showing strong, diffuse cytoplasmic immunopositivity. (c) Cytokeratin 20 immunohistochemically stained section showing immunonegativity. (d) Gata3 labeled section showing strong nuclear positivity.
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F2
Immunohistochemical analysis of the PM revelaed positivity for ER, PR, and HER2 [Figures 2a-d].