PMC4174594_01
(A and B) Preoperative gadolinium-enhanced T1 weighted MRI: lesion measuring 19 mm vertical length near the optic chiasm, with irregular peripheral enhancement. (C and D) Postoperative gadolinium-enhanced T1 weighted MRI: persistence of heterogeneous asymmetrical mass with infiltration of the sphenoidal sinus near the optic chiasm. (E and F) Nonenhanced MRI: significant reduction in tumor size 4 months after starting meprednisone treatment.
edmcr-2014-140062-g001.jpg
PMC4174594_01_edmcr-2014-140062-g001.jpg
fig1
Brain magnetic resonance imaging (MRI) revealed a sellar tumour with suprasellar extension (Fig. 1A and B). Three months later a new MRI of the pituitary gland showed a persistent suprasellar tumour (Fig. 1C and D) in spite of lack of symptoms. An MRI repeated after four months showed significant reduction in the pituitary mass lesion, demonstrating a good response to the low-dose steroids (Fig. 1E and F).
(A) Pituitary gland pathology report: dense inflammatory lymphoplasmacytic infiltrates. (B) IgG4-positive immunostaining in more than ten plasma cells per high power field (arrows, 40x).
edmcr-2014-140062-g002.jpg
PMC4174594_01_edmcr-2014-140062-g002.jpg
fig2
Histopathology revealed adenohypophyseal tissue with dense inflammatory lymphoplasmacytic infiltrates (Fig. 2A). IgG4-positive immunostaining was observed in more than ten plasma cells per high power field (40x), confirming IgG4-related hypophysitis diagnosis (Fig. 2B).
PMC4174594_02
(A and B) Preoperative nonenhanced MRI: an extensive intrasellar lesion expanding into suprasellar region was found, with signs of bleeding, compression and optic chiasm displacement. (C and D) Postoperative nonenhanced MRI under meprednisone treatment showed significant reduction in sellar mass size.
edmcr-2014-140062-g003.jpg
PMC4174594_02_edmcr-2014-140062-g003.jpg
fig3
A repeat MRI performed 30 days after surgery showed a substantial reduction in sellar lesion size (Fig. 3C and D) and her CVF test improved.
(A) Pituitary gland histopathology report: dense lymphoplasmacytic inflammatory infiltrates. (B) IgG4-positive immunostaining in more than ten plasma cells per high power field (arrows).
edmcr-2014-140062-g004.jpg
PMC4174594_02_edmcr-2014-140062-g004.jpg
fig4
Histopathology results reported IgG4-related hypophysitis (Fig. 4A and B) and treatment was changed to meprednisone 16 mg daily.