PMC4508754_01
a, b: Preoperative nonenhanced images reveal a suprasellar mass. The "cyst" (arrows) is hypointense on T1-weighted image and hyperintense on T2-weighted image.
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F1
The computed tomography (CT) and magnetic resonance imaging (MRI) examinations revealed a solid suprasellar mass of 2.5 cm diameter (Fig. 1a, b). The tumor was shown to contain a "cystic" component (Fig. 1a, b).
a, b: The preoperative and postoperative images with contrast. a: Showing a markedly enhancing suprasellar mass. The arrow notes the hypointense area of flow voids. b: Showing the small piece of tumor remained (arrow).
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F2
And strong enhancement was observed after intravenous (i.v.) administraion of Gd-DTPA (gadolinium diethylene triamine pentacetate) (Fig. 2a). MRI during the follow-up period demonstrated subtotal removal of the tumor (Fig. 2b).
a: The 3D-MPRAGE MR image showed the blood sinus in the tumor with stronger enhancement. Both 3D-MPRAGE MR and 3D-FIESTA MR, b: revealed the small vital structures around the tumor, c: CTA image demonstrates blood supply by multiple small vessels (arrows). ACA: anterior cerebral artery, BS: blood sinus, CTA: computed tomography angiography, P: pituitary, PS: pituitary stalk, T: tumor, 3D-FIESTA MR: three dimensional fast-imaging employing steady acquisition sequence magnetic resonance, 3D-MPRAGE MR: three dimensional magnetization prepared rapid acquisition with gradient echo sequence magnetic resonance.
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After enhancement, the "cystic" component was more prominent than solid tumor on 3D-MPRAGE MR (three dimensional magnetization prepared rapid acquisition with gradient echo sequence magnetic resonance) (Fig. 3a). The anterior cerebral artery (ACA) could be found in front of the tumor, while the pituitary stalk was behind the tumor (Fig. 3b). Computed tomography angiography (CTA) demonstrated blood supply to the mass from multiple small perforating arteries arising from the ACA and posterior communicating artery (Fig. 3c).
Pictures during the operation. a: After we open the dural matter, the tumor was found through the semitransparent arachnoid membrane. b: Dissecting the tumor from the complex of anterior cerebral atery. ACA: anterior cerebral artery, A2: segment of the anterior cerebral artery, dm: dural matter, am: arachnoid membrane, T: tumor.
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The dural matter was cut in "T" shape and coagulated at the bilateral edges (Fig. 4a). After opening the arachnoid membrane, we observed the ACA complex on the tip of the tumor (Fig. 4b).
Histopathology of the resected specimen shows thin-walled vessels and lipid-filled stromal cells (arrow) (H and E x200).
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F5
Histopathologically, the tumor had numerous capillary vessels, each composed of a single layer of endothelial cells without nuclear heteromorphism and characteristically lipid-filled stromal cells (Fig. 5).