PMC4389828_01
(a) Sagittal T1-weighted MRI of the head shows a suprasellar, high-intensity mass suspected to represent RCC. PA located below the RCC shows isointensity. (b) Sagittal T2-weighted MRI of the head shows isointense RCC and isointense PA. (c) Contrast-enhanced axial MRI shows nonenhancing RCC. In contrast, the normal pituitary gland shows strong enhancement. (d) Contrast-enhanced coronal MRI shows slight compression of the optic chiasma by RCC. And it shows an intrasellar PA of 9 mm in diameter located on the left of normal gland and suprasellar RCC of 12 mm in diameter that compressed stalk to the right side.
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T1-weighted MR image (Figure 1(a)) and also isointense on T2-weighted MR image (Figure 1(b)). These findings for the suprasellar mass were compatible with RCC, and he was referred to the neurosurgical outpatient clinic for management. In conjunction with the findings from Gd-enhanced MRI, a diagnosis of GH-producing PA was made (Figures 1(c) and 1(d)).
No visual disturbance was apparent.
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No visual disturbance was apparent (Figures 2(a) and 2(b)).
(a) Neuroendoscope shows the clear margin between normal gland and PA. PA looks soft and yellowish. (b) Neuroendoscopic view after removal of the PA, which was easy to remove. (c) Neuroendoscope shows the wall of the RCC. Resecting the suprasellar RCC while retracting normal gland was difficult. (d) The floor of the sella turcica was reconstructed using fat tissue. We did not aspirate or resect the cyst wall.
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Intraoperatively, the margin between the normal pituitary gland and adenoma was clear (Figure 3(a)). We identified the yellowish adenoma and completed gross total removal using suction (Figure 3(b)). We then retracted the pituitary gland and identified the wall of the RCC (Figure 3(c)). The floor of the sella turcica was reconstructed using fat tissue (Figure 3(d)).
(a) Photomicrograph shows the tumor is composed of monotonous eosinophilic cells. (H&E stain, original magnification x400.) (b) Positive staining is observed with GH immunohistochemistry. (GH, original magnification x400.)
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Histologically, the tumor was composed of monotonous eosinophilic cells (Figure 4(a)).