PMC4508743_01
Initial gadolinium-enhanced T1-weighted magnetic resonance (MR) imaging demonstrating the tumor in the sella. (A: sagittal image, B: coronal image).
nmc-53-707-g1.jpg
PMC4508743_01_nmc-53-707-g1.jpg
F1
March 1996, as previously described. Magnetic resonance (MR) imaging showed an intrasellar tumor (Fig. 1A, B).
Gadolinium-enhanced T1-weighted magnetic resonance (MR) imaging well-demarcated tumors on the dorsal side of the cervicomedullary junction, the C3 and the C5. (A: sagittal image, B-D: axial image).
nmc-53-707-g2.jpg
PMC4508743_01_nmc-53-707-g2.jpg
F2
MR imaging of the brain and cervical cord showed a gadolinium-enhanced solid tumor at the cervicomedullary junction, compressing the medulla (Fig. 2A, B). In addition, extramedullary solid tumors at the level of the C3 and the C5 were also seen (Fig. 2C, D).
Postoperative magnetic resonance (MR) imaging revealing complete removal of the tumors. (A: sagittal image, B-D: axial image).
nmc-53-707-g3.jpg
PMC4508743_01_nmc-53-707-g3.jpg
F3
Postoperative MR imaging revealed that the tumors had been completely removed (Fig. 3).
Photograph of histopathologic findings from the tumors. A: The intrasellar tumor obtained from the initial surgery showed findings that are typical of pituitary adenoma. B: The parietal tumor obtained from the fourth surgery shows sheets of cells with pleomorphic nuclei with abundant cytoplasm and mitoses. C: The cerebellar tumor shows necrosis. D: The tumor in the medulla shows sheets of cells with round nuclei and sporadic mitoses with abundant microcapillaries. E: The tumor in the C3 shows faint staining of nuclei with hematoxylin with abundant microcapillaries. F: The tumor in the C5 shows a cluster of the tumor cells with pleomorphic nuclei and necrosis.
nmc-53-707-g4.jpg
PMC4508743_01_nmc-53-707-g4.jpg
F4
Histologic examination revealed that the tumors in the pituitary fossa consisted of uniformly sized cells with uniform round nuclei (Fig. 4A). The tumor in the parietal lobe (the second surgery) displayed moderately pleomorphic nuclei and amphophilic cytoplasm (Fig. 4B). The tumor in the cerebellum had marked necrosis (Fig. 4C). The tumor in the medulla and the C3 had cells with hyperchromatic nuclei that intermingled with connective tissue including abundant capillaries (Fig. 4D, E). The tumors in the C5 displayed tumor cells with pleomorphism and poor differentiation (Fig. 4F).
Time course of serum levels of growth hormone (GH) and somatomedin C. Serum level of GH declined gradually with recurrence of the tumor.
nmc-53-707-g5.jpg
PMC4508743_01_nmc-53-707-g5.jpg
F5
Serum levels of GH and somatomedin C are shown in Fig. 5. Levels of GH declined with progressive dissemination of the tumor and corresponded to the histologic findings of differentiation of the adenoma (Fig. 5).