PMC5357528_01
Pituitary MRI appearances (T1 postgadolinium weighted sagittal images). (a) After the first transsphenoidal operation for macrocorticotropinoma in 2010 with a small tumor remnant. (b) Three years after the first operation. Pituitary adenoma with destruction of the floor of the sella and invasion into sphenoid sinus and both cavernous sinuses. (c) Three months after the initiation of the concurrent therapy with TMZ and radiotherapy. (d) After the 6 cycles of TMZ. Stable pituitary remnant and biochemical control of the disease.
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The surgery led to biochemical remission with a presence of a small tumor remnant (Figure 1(a)). MRI confirmed tumor progression in sphenoid and ethmoid sinuses, both cavernous sinuses, with infiltration of the sellar wall, clivus, and chiasmal compression (Figure 1(b)). Postoperative MRI confirmed a large tumor remnant with infiltrative growth pattern destructing the bone (Figure 1(c)). The patient was in a significantly better clinical condition, on hydrocortisone replacement therapy and without major complaints or adverse events. The MRI after 3 and 6 months of therapy showed further tumor regression (Figure 1(d)).
(a) HE staining of the pituitary macroadenoma tissue confirming atypical pituitary adenoma (magnification x100). (b) Ki-67 positivity in tumor tissue of 10-20% (magnification x400). (c) p53 positivity in less than 5% of cells (magnification x400).
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Ki-67 was 10-20% and p53 positivity was present in less than 5% of cells (Figure 2).