PMC5362926_01
Transverse T1-weighted magnetic resonance images at the level of the pituitary fossa (PF) with (a) pre- and (b) post-contrast (gadolinium) sequences. The suprasellar mass is hyperintense relative to the surrounding parenchyma and strongly contrast enhancing. There is a moderate degree of asymmetrical compression of the thalamus (T)
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Aperto). A large (10 x 12 x 12 mm), extra-axial, suprasellar mass was seen, with extension ventrally into the sphenoid bone (Figure 1a). T2 isointense. The mass had a heterogeneous cystic appearance with loculated T1 hypointense foci and was strongly contrast enhancing on T1-weighted sequences in response to IV administration of a gadolinium-based agent (0.01mg/kg Gadovist [gadobutrol]; Bayer Healthcare Pharmaceuticals) (Figure 1b). The fluid-attenuated inversion recovery sequence identified an irregular hyperintensity surrounding the mass and extending through the right thalamus into the right caudate nucleus rostrally, consistent with peritumoural oedema (Figure 2).
Transverse fluid-attenuated inversion recovery image at the level of the middle cranial fossa. An irregular hyperintensity (consistent with oedema) is seen surrounding the mass and extending into the right thalamus and corona radiata
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T2 isointense. The mass had a heterogeneous cystic appearance with loculated T1 hypointense foci and was strongly contrast enhancing on T1-weighted sequences in response to IV administration of a gadolinium-based agent (0.01mg/kg Gadovist [gadobutrol]; Bayer Healthcare Pharmaceuticals) (Figure 1b). The fluid-attenuated inversion recovery sequence identified an irregular hyperintensity surrounding the mass and extending through the right thalamus into the right caudate nucleus rostrally, consistent with peritumoural oedema (Figure 2).
A sagittal T2-weighted magnetic resonance image at the midline. An intracranial mass is seen protruding dorsally from the pituitary fossa (white arrows). The fossa is widened owing to invasion of the sphenoid bone locally. A 'mass effect' is resulting in mild caudal cerebellar herniation through the foramen magnum (black arrows) and compression of the interthalamic adhesion (circled). Mild caudal transtentorial herniation is also seen
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There was a marked mass effect, with local compression of the thalamus and hypothalamus, mild caudal transtentorial herniation, and mild caudal cerebellar herniation (Figure 3).
Post-mortem examination. (a) Ventral view of the fixed brain after the tumour had been shelled out. Note the asymmetric impingement on the hypothalamus (HT) and right-sided crus cerebri (CC) with dilation of the infundibular recessus (IR) and oblique caudal compression of the optic chiasm (OC) and tracts. Scale bar = 1 cm. (b) Macroscopic appearance of the pituitary tumour. Scale bar = 0.8 cm. (c) Histology of the mass is characterised by a proliferation of neuroendocrine cells, often confined to Zellballen (ZB), surrounded by vascular septa (VS). Scale bar = 200 microm. (d,e) Tumour cells stain positive for synaptophysin (Syn) and chromogranin (Chrom). Scale bar = 100 microm. PL = piriform lobe
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Post-mortem examination was performed and histopathological assessment of the brain confirmed the presence of a neuroendocrine pituitary macroadenoma (Figure 4). Although functional assessment of the pituitary gland was not performed ante-mortem, immunohistochemical staining of the tumour cells was positive for chromogranin and synaptophysin, confirming their neuroendocrine origin (Figure 4).