PMC9758545_01
Coronal T1-weighted (A) pre-contrast and (B) post-contrast magnetic resonance imaging of the pituitary showing a homogenously enhancing dumbbell-shaped sellar mass measuring 2.8 cm x 3.6 cm x 3.8 cm. On non-contrast sagittal view, it is (C) T1-hypointense with heterogenous intensity on (D) T2. There is T1 hyperintensity (red arrow) and T2 hypointensity (yellow arrow) at the peripheral aspect of the mass suggestive of hemorrhage. The posterior bright spot is absent.
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Pituitary magnetic resonance imaging (MRI) revealed a large, solid sellar lesion with suprasellar extension measuring 2.8 cm x 3.6 cm x 3.8 cm, compressing the optic chiasm and abutting the cavernous sinuses (Figure 1).
(A) Histopathology of the collision tumor showing a focus of metastatic adenocarcinoma (m) adjacent to pituitary adenoma (pa) (H&E, 10x). (B) The metastatic adenocarcinoma displayed pleomorphic cells arranged in papillary architecture (H&E, 10x). Immunohistochemical staining revealed positive staining for (C) cytokeratin 7 (CK7) and (D) thyroid transcription factor-1 (TTF-1).
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These tumor cells stained positive for cytokeratin 7 (CK7) and thyroid transcription factor-1 (TTF-1), suggestive of metastatic lung adenocarcinoma (Figure 2).
Immunohistochemical staining of the pituitary adenoma at 10x magnification, with positive staining for (A) synaptophysin, (B) growth hormone (GH), (C) adrenocorticotropic hormone (ACTH) and (D) prolactin.
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These neoplastic pituitary cells stained positive for synaptophysin, growth hormone (GH), adrenocorticotropic hormone (ACTH) and prolactin, suggestive of pituitary adenoma (Figure 3).
Computed tomography scan with contrast on axial view of the (A) thorax and (B) abdomen revealing a lobulated lesion at right perihilar area encasing the right pulmonary veins (yellow arrow), bilateral adrenal masses (red arrows) and bilobed right adrenal mass.
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A CT scan of the chest, abdomen and pelvis for further metastatic workup showed a new right upper lung lobe mass measuring 2.4 cm x 1.5 cm, an enlarged right perihilar mass measuring 4.0 cm x 3.1 cm x 2.1 cm, and bilateral adrenal masses which were unchanged in terms of size (Figure 4).