PMC5288990_01
(a) Computed tomography (plain) of the brain at presentation showing the hemorrhagic lesion in the third ventricle obstructing the foramen of Monro and causing hydrocephalus; magnetic resonance imaging demonstrating [(b) T1-weighted axial, (c) T2-weighted sagittal, (d) Susceptibility-weighted Imaging (SWI) axial, (e) contrast-enhanced T1-weighted axial, and (f) contrast-enhanced T2-weighted sagittal images] a pituitary macroadenoma with suprasellar extension with evidence of apoplectic change
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F1
Electrocardiograph (ECG) showed sinus bradycardia and computed tomography (CT) scan of the brain showed sellar and suprasellar hemorrhagic lesion with obstruction of the foramen of Monro, leading to hydrocephalus [Figure 1a]. The lesion was T1 isointense, T2 hyperintense with areas of T2 hypointensity, and was heterogeneously enhancing on contrast [Figure 1b-f]. On susceptibility-weighted images (SWI), intratumoral hemorrhage was clearly documented [Figure 1c].
(a) Microphotograph showing fragmented bits of a cellular neoplasm with hemorrhage (hematoxylin and eosin x100). (b) Microphotograph showing an endocrine neoplasm with cells arranged in organoid nests and conglomerate acinar, solid clusters (hematoxylin and eosin x400). Note the uniform cells and regular nuclei with homogenous chromatin; (c) Microphotograph showing cells positively stained for ACTH immuno-stain (ACTH-IHC x400) (d) Microphotograph showing cells negatively stained for growth hormone immunostain (GH-IHC x400)
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F2
Histopathology sections showed fragments of an endocrine neoplasm composed of sheets, lobules, and papillaroid clusters of round-to-polyhedral cells having moderate amphophilic cytoplasm and a regular round-to-oval nucleus [Figure 2a and b]. The tumor was ACTH-positive and negative for all other IHC markers [Figure 2c and d].
Magnetic resonance imaging [(a) contrast-enhanced T1-weighted coronal and (b) contrast-enhanced T2-weighted sagittal images] at 6-month follow-up exhibiting near total resection of the pituitary adenoma
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F3
At 6-month follow-up, the patient is doing well with only residual bitemporal hemianopia and MRI brain revealed minimal residual lesion [Figure 3a and b].