PMC9610038_01
(a) A high-density mass was seen on sagittal computed tomography in 2017 (white arrow). (b) T1-weighted sagittal image with iso-intensity showing the tumor located at the tuberculum sellae. (c) When the suprasellar tumor was initially found, the patient's visual field test on the right eye showed upper temporal quadrantanopsia.
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F1
A tumor of the tuberculum sellae was observed on whole-body computed tomography in 2017 [CT; Figure 1a], but it was not recognized. Magnetic resonance imaging (MRI) revealed a tumor (25 x 18 x 19 mm) in the tuberculum sellae [Figure 1b]. Humphrey perimetry revealed upper temporal quadrantanopsia [Figure 1c], but his visual acuity was intact (20/20). His serum prostate-specific antigen (PSA) was within the normal range at 3.900 ng/mL and his pituitary hormone level was also normal.
(a) Two months later, his visual acuity and field were aggravated. (b) Gadolinium T1-weighted image showing tumor growth with homogeneous enhancement two months later. Dural enhancement can also be seen. (c) Fast imaging with steady-state acquisition revealed that the right optic nerve (white arrow) was compressed by the tumor.
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F2
Humphrey perimetry revealed progressive visual field disturbance [Figure 2a]. MRI showed tumor growth (27 x 24 x 25 mm) with homogeneous and dural enhancement [Figure 2b]. Fast imaging with steady-state acquisition revealed that the right optic nerve was compressed by the tumor [Figure 2c] and malignant meningioma was suspected.
(a) Atypical epithelioid cells with vacuole proliferated in a sheeting pattern and focal gland-like formation can be seen (hematoxylin-eosin stain). (b and c) Immunohistochemically, the gland-like region was positive for prostate-specific antigen, and the nuclei of the tumor cells were diffusely positive for androgen receptor.
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F3
The gland-like formation was immunopositive for PSA and androgen receptor [Figures 3a-c].
(a) The tumor disappeared after radiation therapy following transsphenoidal surgery. (b) The visual field disorder improved with the disappearance of the tumor.
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F4
The tumor disappeared on MRI [Figure 4a] and his visual impairment improved [Figure 4b].