PMC7450332_01
(a) Coronal postcontrast fat-saturated image demonstrates a heterogeneous sellar mass, which expands the sella (short thick arrow). There is also a slight suprasellar extension. The pituitary stalk is also involved and thickened (thin arrow). (b) Sagittal postcontrast fat-saturated image also demonstrates the heterogeneous sellar mass (thin arrow). (c) Coronal T2 image shows a mild mass effect on the optic chiasm from the thickened pituitary stalk (thin arrow).
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There was a small amount of suprasellar extension with mild mass effect on the optic chiasm (Figures 1(a)-1(c)).
Coronal postcontrast image demonstrates the size of the mass upon initial imaging (a) also including the measurement of the mildly thickened pituitary stalk. At the time of follow-up imaging (b), the mass has slightly increased in size, which is most notable at the pituitary stalk, which now measures 7 mm in thickness, previously 4.6 mm. Also, note the mild increased mass effect on the optic chiasm (thin arrow) at the time of follow-up imaging on the coronal T2 image (c).
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Repeat MRI in 3 months noted interval increase in the bulk of the tumor extending along the infundibulum, now measuring 0.7 cm in transverse width compared to 0.4 cm previously, and there was resulting interval mild increased mass effect on the optic chiasm at its central and left aspect (Figures 2(a)-2(c)).
Pituitary tumor excision showing tumor nests of clear cells separated by fibrovascular septa (H&E stain: (a) x2.5; (b) x10).
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Surprisingly, pathology of the resected pituitary mass after proper fixation showed metastatic renal cell carcinoma (Figures 3 and 4).
Immunohistochemical stains positive for renal cell carcinoma (a) and (b) and negative for neuroendocrine markers (c) and (d). (a) CD10 immunostain (x10). (b) PAX-8 immunostain (x5). (c) Synaptophysin (x2.5). (d) Chromgranin (x2.5).
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Surprisingly, pathology of the resected pituitary mass after proper fixation showed metastatic renal cell carcinoma (Figures 3 and 4).
Right kidney, radical nephrectomy: clear cell renal cell carcinoma, WHO/ISUP histologic grade 2. The tumor measures 10.5 cm in greatest dimension, limited to kidney.
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As a result, a cytoreductive robotic right radical nephrectomy was performed, which confirmed WHO/ISUP histologic grade II clear cell renal cell carcinoma on pathology, stage pT2b pNX pM1 (Figure 5).
Most recent postoperative scan demonstrates residual enhancing heterogeneous mass in the sella (thin arrow) on the coronal postcontrast image (a). The sagittal postcontrast image (b) also demonstrates the residual heterogeneous mass (thin arrow). Also, note the postsurgical changes in the adjacent sphenoid sinus and posterior ethmoid air cells from a trans-sphenoidal approach to the sella (short thick arrow).
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Repeat MRI 3 months after surgery and one year after surgery noted the sellar mass was stable with the thickened infundibulum causing mass effect upon the optic chiasm (Figures 6(a) and 6(b)).