PMC3560274_01
Initial coronal (a) magnetic resonance imaging showing normal appearance of the sella turcica and pituitary gland, and follow-up coronal (b) magnetic resonance imaging showing a less enhanced area in the left lateral wing of the sella turcica.
1752-1947-7-27-1.jpg
PMC3560274_01_1752-1947-7-27-1.jpg
F1
A head magnetic resonance imaging (MRI) with contrast medium revealed thickening of the bilateral ocular muscles, but no evident tumor in the sella turcica (Figure 1a). All other pituitary hormones were within the normal ranges, and head MR imaging with contrast medium showed an area of less enhancement in the left lateral wing of the sella turcica with a diameter of 5mm (Figure 1b), and transsphenoidal surgery was planned under a diagnosis of TSH-secreting pituitary adenoma.
Serial evaluation of pituitary thyroid hormones. PTU: propylthiouracil, TRAb: anti-thyroid stimulating hormone receptor antibody,TSH: thyroid-stimulating hormone.
1752-1947-7-27-2.jpg
PMC3560274_01_1752-1947-7-27-2.jpg
F2
Re-elevation of TSH was seen in December 2010 (Figure 2).
Photomicrographs of the surgical specimen of the sellar tumor showing diffuse cell arrangement with mild variation in size but without atypism or mitosis of the nucleus. Hematoxylin and eosin staining, original magnification x 40 (a), x 80 (b), and immunohistochemical staining for anti-thyroid-stimulating hormone-beta (c), PRL indicates anti-prolactin (d) antibody. Original magnification x 40. Number indicates magnification of the objective lens.
1752-1947-7-27-3.jpg
PMC3560274_01_1752-1947-7-27-3.jpg
F3
Postoperative histological examination showed diffuse cell arrangement with mild variation in size but without atypism or mitosis of the nucleus (Figure 3a,b). Immunohistochemical examination disclosed plurihormonal expression of pituitary hormones including TSH-beta, and the diagnosis was established as TSH-secreting plurihormonal adenoma (Figure 3c,d).