PMC6744763_01
Top: Contrast-enhanced T1-weighted sagittal cross- sectional magnetic resonance imaging at initial diagnosis (2005). Bottom: Same study, coronal cross-section. Evidence of a 22 mm x 20 mm x 15 mm prolactinoma with chiasm/bilateral optic nerve upward dislocation.
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F1
The ensuing radiological assessment revealed a 22 mm x 20 mm x 15 mm pituitary mass with chiasmatic/bilateral optic nerve upward dislocation [Figure 1]; the complementary endocrine screening showed evidence of a growing prolactinoma (March 2005). Metastatic activity was reported almost 12 years after initial diagnosis [Figures 2-4 and Table 1], remaining largely unresponsive to multimodal treatment.
Follow-up contrast-enhanced T1-weighted axial cross- sectional magnetic resonance imaging (November 2017) showing a 10-mm left-sided frontal lesion within the anterior limits of the falx cerebri: Suspected metastatic lesion (pituitary carcinoma).
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F2
Metastatic activity was reported almost 12 years after initial diagnosis [Figures 2-4 and Table 1], remaining largely unresponsive to multimodal treatment.
(x400). Microscopic reassessment of samples from second metastasectomy (November 2017) for the purpose of this article (a) H&E staining: high mitotic activity in a population of large cells with atypical nuclei and prominent nucleoli. (b) KI67: high proliferation (35%). (c) Overexpression of P53 limited to a few tumor cells (anti-p53 antibody). (d) Diffuse Immunostaining for prolactin. Of note, thyroid stimulating hormone, growth hormone, adrenocorticotropic hormone, CK-AE1AE3 proved negative. Samples from the first metastasectomy were not made available for reanalysis.
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F3
Metastatic activity was reported almost 12 years after initial diagnosis [Figures 2-4 and Table 1], remaining largely unresponsive to multimodal treatment.
Top: Follow-up contrast-enhanced T1-weighted axial cross-sectional magnetic resonance imaging (January 2018): new metastatic lesion within the limits of the chiasm. Bottom: the same study exposing a concurrent frontobasal metastasis.
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F4
Metastatic activity was reported almost 12 years after initial diagnosis [Figures 2-4 and Table 1], remaining largely unresponsive to multimodal treatment.