PMC6069369_01
Magnetic resonance (MR) images in sagittal T2 (a), T1 coronal (b), and T1 coronal after contrast (c) reveal a lesion in suprasellar cistern. It is characterized by heterogeneous hyperintensity in T2, with gross enhancement by gadolinium (arrow heads). Vascular structures are seen in the interior of lesion, with flow-voids (white arrows). It compresses and pushes anteriorly the optic chiasm, changing its sign (descontinuous arrow). Adenohypophysis is apart from the lesion (red arrow)
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F1
T2 sequences and with avid postcontrast enhancement after application of i/v gadolinium. The lesion was centered in the suprasellar cistern at the expected site of pituitary stalk and compressed and displaced the optic chiasm. The tumor extended superiorly toward the floor of the third ventricle, compressing the hypothalamus bilaterally, without an apparent discernable tissue plane separating it from adjacent structures [Figure 1].
Coronal (a) and sagittal (b) postoperative skull computed tomography (CT) showing resection of tumor, hemostatic material in surgical bed (white arrows), pneumocranium (arrow head), and blood contente in left lateral fissure (red arrow)
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F2
The postoperatively period was uneventful, except some transient diabetes insipidus which resolved spontaneously by the fourth postoperative day [Figure 2].
Late (3 months) MR. Sagittal (a), axial (b), and coronal (c and d) images revealing residual tumor in surgical site
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F3
Late postoperative MRI (at 3 months) revealed some residual tumor but adequately decompressed optic pathways [Figure 3].
Histology image. (a) Hematoxylin-eosin x200 view; fusiform cells. (b) Hematoxylin-eosin x200; revealing epithelioid pattern with moderate cellularity, sometimes rounded nuclei, sometimes elongated, and broad eosinophilic cytoplasm. (c) Positive staining for GFAP. (d) Positive staining for TTF-1
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F4
S-100, Vimentin, TTF-1, ATRX, and BCL-2. Staining was negative for EMA, Synaptophysin, P53, HDI-1, NEUN, and CK8/18; The cell proliferation index (estimated by Ki-67) was low at about 1% [Figure 4].