PMC7193214_01
Preoperative MRI showing a sellar mass lesion with less enhancement with gadolinium (a). Postoperative T1- weighted postcontrast image showing complete tumor removal with preservation of the pituitary gland and stalk (b). Skull X-ray showing prominence of the jaw and mild frontal bossing (c). Hand X-ray revealing cauliflower appearance at the distal phalanx of the hands (d).
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F1
Magnetic resonance imaging (MRI) of the brain revealed a pituitary tumor measuring 12 x 10 x 9 mm, without cavernous sinus invasion [Figure 1a and b]. Radiography of the skull and extremities showed prominence of the jaw and cauliflower appearance of the hands [Figure 1c and d]. The GH reduced to 0.9 ng/ml on postoperative day 6, with normalized IGF-1 (402 ng/ml) in the following week, and postoperative imaging showed satisfactory tumor resection [Figure 1b].
Intraoperative photographs. The stretched anterior pituitary lobe had covered the tumor (a). The tumor was resected in a double-suction technique intracapsularly (b). The pseudocapsule was resected following internal debulking of the tumor (c). A fat graft was packed into the cavity with a dural stitch following tumor resection (d).
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F2
The pseudocapsule was also removed, and finally gross total resection of the tumor was performed [Figure 2a-d].
Histopathological photographs. The tumor was composed of monomorphic neoplastic cells with eosinophilic cytoplasm (H and E, x100) (a). Most of the neoplastic cells showed immunoreactivity for GH in their cytoplasm (immunohistochemistry, x100) (b). The Ki-67 proliferation index was 3% (22/725) (immunohistochemistry, x100) (c).
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F3
Histopathological diagnosis was confirmed as GH secreting pituitary adenoma [Figure 3a-c].