PMC6232249_01
Preoperative computed tomographic (CT) scanning revealed a large mass lesion in the sellar region (A). Magnetic resonance imaging (MRI) also demonstrated a large lesion located in the sellar region, with heterogeneous enhancement and invasion to both cavernous sinuses (B-D). Subtotal resection was obtained after operation (E,F). A recurrent tumor was involved in the saddle fossa and left cavernous sinus (G,H). Computed tomographic angiography (CTA) ruled out a left posterior communicating artery aneurysm (I). The PET-CT showed a residual intracranial tumor in the left cavernous sinus after a second operation (J). Multiple metastatic lesions were found in the lung (K,L; blue arrow indicates the metastatic lesion).
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F1
A preoperative computed tomographic (CT) scan revealed a large-mass lesion of the sellar region with extreme suprasellar extension (Figure 1A). Magnetic resonance imaging (MRI) demonstrated a large lesion located in the sellar region with heterogeneous enhancement and invasion to both cavernous sinuses (Figures 1B-D). The patient underwent an endonasal transsphenoidal surgery, and subtotal resection was obtained after the operation (Figures 1E-H). Computed tomographic angiography (CTA) was adopted to rule out an aneurysm of the left posterior communicating artery, and no aneurysm was found on CTA (Figure 1I). PC. PET-CT was used for further evaluation and a residual intracranial tumor was observed in the left cavernous sinus (Figure 1J). Multiple metastatic lesions were also found in the lung (Figures 1K,L), and biopsy of these lesions revealed a metastatic neuroendocrine tumor.
Hematoxylin and eosin (H&E) staining showed circular cells with uniform morphology and no heterotypic cells for the first operation specimen (A; original magnification, x200). Immunohistochemical (IHC) staining revealed positive expression for ACTH and P-53 (B,C; original magnification, x200), and Ki-67 expression was essentially negative (D; original magnification, x200). H&E staining revealed excessive pleomorphic cells and frequent mitoses (E; original magnification, x200). IHC staining was positive for the expression of ACTH (F; original magnification, x200), and strongly positive staining for P53 and Ki-67 was observed (G,H; original magnification, x200). Depiction of the protein-protein interaction (PPI) network for the 44 mutant genes involved in pituitary adenomas (I). Depiction of the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways enriched for the 44 mutant genes (J).
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F2
Initial postoperative histopathologic examination revealed a pituitary adenoma, and microscopic evaluation showed that the tumor consisted of circular cells of uniform morphology (Figure 2A). ACTH and P53 (Figures 2B,C), and Ki-67 expression was essentially negative (Figure 2D). A second postoperative histopathologic examination showed the presence of a PC. Hematoxylin and eosin staining also revealed the presence of excessive pleomorphic cells and frequent mitoses (Figure 2E). Immunohistochemical staining was positive for the expression of ACTH (Figure 2F), with strong positive staining for P53 and Ki-67 (Figures 2G,H); in fact, Ki-67 expression was up to 80%. Their protein-protein interaction (PPI) network is shown in Figure 2I. Using these 44 genes, we found enrichment of several GO groups using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database (Figure 2J).