PMC9235429_01
A 42-year-old male with fever, left chest pain, fatigue, severe headache, joint pain, and gynecomastia was diagnosed with systemic sarcoidosis and probable pituitary neurosarcoidosis. Sagittal (panel a) and coronal (panel b) gadolinium enhanced brain MRI showing pituitary adenoma (arrows). PET/CT visualization with integrated maximum intensity projection and transaxial brain PET, fusion and CT imaging showing focal uptakes of 18F-FDG radiotracer in lungs, lymph nodes and liver (arrows) (panel c) and focal uptake in the pituitary gland (arrow) (panel d). PET/CT visualization with integrated maximum intensity projection and transaxial brain PET, fusion and CT imaging showing complete disappearance of lung, lymph nodes and liver uptakes (panel e) as well as the focal uptake in the pituitary gland (panel f) after treatment. Photomicrograph of biopsy samples stained with hematoxylin and eosin showing confluent sarcoid granulomata pattern with multinuclear giant cells Langhans type, mononuclear phagocytes, and lymphocytes in lymph node (panel g) and liver tissue (panel h), no necrosis was present (x100).
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F1
Brain magnetic resonance imaging (MRI) after enhancement with gadolinium identified a pituitary adenoma [Figure 1, panels a and b]. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18FDG-PET/CT) scan showed multiple uptakes in the lungs, liver, and lymph nodes above and below the diaphragm [Figure 1, panel c]. In addition, a marked uptake was detected in the pituitary gland [Figure 1, panel d]. Surgical biopsies from thoracic lymph node and liver revealed confluent noncaseating granulomas with multinuclear giant cells, mononuclear phagocytes, and lymphocytes without necrosis [Figure 1, panels g and h]. Consortium Consensus Group criteria. Clinical and radiological remission [Figure 1, panels e and f] was achieved after a combined 18-month treatment with steroids, methotrexate, and bromocriptine, followed by normal prolactin levels.]