PMC7568121_01
(a and b) Noncontrast-enhanced computed tomography scan head in sagittal reconstruction. (a) Discloses isodense expansile lesion completely involving the clivus and extending into the posterior sphenoid cavity as well as into sella. (b) On bone windows, it is an osteolytic lesion completely destroying the whole length of clivus from basiocciput to basisphenoid, dorsum sella, and sellar floor.
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F1
CT scan and MR images of a 32-year-old nondiabetic female who presented with complaints of headache for the past 4 months and double vision of 3 months' duration are shown in [Figures 1 and 2]. As shown in [Figure 1a], the lesion on CT scan appears to be an isodense pathology with expansile nature, grossly involving the clivus, and extending into posterior sphenoid cavity as well as into sella. On bone window [Figure 1b], it is appearing to be an osteolytic lesion completely destroying whole length of clivus extending from basiocciput to basisphenoid, invading dorsum sella to sellar floor.
(a-f) T1- and T2-weighted magnetic resonance imaging, sagittal, and coronal images (a-c). Isointense well-defined lesion on T1-W sagittal cuts (a) seems to fill the posterior part of the sphenoid cavity, whole of the sella, and almost reaching up to the tuberculum sella. The lesion is hypointense on T2-W images (b) suggestive of high fibrous component of the tumor. T1-weighted magnetic resonance imaging with gadolinium, axial, coronal, and sagittal Images (d-f). The lesion is brilliantly enhancing on gadolinium administration, with encasement of bilateral cavernous internal carotid arteries are clearly visible.
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F2
CT scan and MR images of a 32-year-old nondiabetic female who presented with complaints of headache for the past 4 months and double vision of 3 months' duration are shown in [Figures 1 and 2]. The soft-tissue component of the lesion is better delineated on MRI, as shown in [Figure 2a-f]. Isointense well-defined lesion on T1-W MR images sagittal cuts [Figure 2a] seem to fill posterior part of the sphenoid cavity, whole of the sella, and almost reaching up to the tuberculum sella. Lesion is hypointense on T2-W images [Figure 2b] suggestive of high fibrous component of the lesion. Bilateral internal carotid arteries were seen to be encased by the lesion [Figure 2c]. All these features are also noted in current case, as shown in [Figure 2d-f].
(a and b) Hematoxylin and eosin stained preparations of squash smear (a) and frozen section (b) showing the presence of mixed inflammatory infiltrate with foreign body type giant cells containing branching septate fungal hyphae.
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F3
Aspergillus flavus growth was seen after aerobic incubation of tissue sample for four weeks, as seen in [Figure 3].