PMC8632214_01
(A) Crooke cells exhibiting wide glassy pale eosinophilic cytoplasm with intranuclear or perinuclear vacuoles (H&E, x400). (B) Breakdown of reticulin network in the lesion (Gordon's reticulin, x400). (C) ACTH cytoplasmic immunoreactivity at the periphery of the cell (ACTH, x400). (D) Periodic acid-Schiff (PAS) positivity staining stronger at the periphery of the cell (x400).
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The morphological changes were consistent with a pituitary adenoma, with a loss of reticulin network ( Figure 1B ). The cells displayed a pathological appearance with a glassy pale eosinophilic cytoplasm, with intranuclear or perinuclear vacuoles, consistent with Crooke's hyaline change ( Figure 1A ). ACTH cytoplasmic immunoreactivity was found at the periphery of the cell ( Figure 1C ); PAS positivity was found, stronger at the periphery ( Figure 1D ).
T1-weighted pituitary magnetic resonance imaging before (A, C) and after (B, D) treatment with capecitabine and temozolomide. (A) Pre-CAPTEM sagittal image shows an increase in the size of the seal tumor (26 mm) with a subacute bleeding component. (B) Post-CAPTEM sagittal image shows a decrease of 65% with a total size of 9 mm. (C) Pre-CAPTEM pituitary coronal image shows invasion of clivus and protrusion into the sphenoid sinus. (D) Post-CAPTEM coronal image shows a decrease in size of the lesion, more prominent at the right level.
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ACTH levels at 1,838 pg/ml and chromogranin A of 41.5 ng/ml (range, 0-101.9 ng/ml). A pituitary MRI ( Figures 2A, C  ) reported an increase in the size of the pituitary tumor that invaded the clivus, a subacute bleeding component that affected the right margin of the tumor (9 x 14 mm), and an invasion of both cavernous sinuses extending to the lateral carotid line (Knosp grade III). After 14 months of initial CAP-TMZ treatment, the last pituitary MRI showed a 65% shrinkage of the tumor ( Figures 2  and  3B, D  ) compared with the prior brain MRI ( Figures 3A, C  ).
T2-weighted pituitary magnetic resonance imaging before (A, C) and after (B, D) treatment with capecitabine and temozolomide. (A) Pre-CAPTEM axial image. (B) Post-CAPTEM axial image shows a decrease in size of 65% with prominent cystic degeneration. (C) Pre-CAPTEM pituitary coronal image. (D) Post-CAPTEM coronal image shows a decrease in lesion.
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After 14 months of initial CAP-TMZ treatment, the last pituitary MRI showed a 65% shrinkage of the tumor ( Figures 2  and  3B, D  ) compared with the prior brain MRI ( Figures 3A, C  ).