PMC7538984_01
The axial T2 image (a) shows two discrete heterogeneous extra-axial lesions at suprasellar cistern (white arrow) and left frontal convexity (red arrow). The axial (b), sagittal, (c) and oblique coronal (d) contrast-enhanced T1 scan shows a sellar lesion with suprasellar extension extending till the floor of third ventricle (asterisk) consistent with pituitary macroadenoma. The heterogeneous solid cystic enhancing lesion at the left frontal convexity is dural based, shows extension into the left frontal sinus (yellow arrow). Note that both the lesions are discrete with normal brain parenchyma between them. Postoperative scan (e and f): the postcontrast T1 axial image shows complete resection of the left frontal convexity meningioma (asterisk in Figure f) with postoperative dural thickening at operative site. Persistent enhancing pituitary macroadenoma (white arrow) is seen in the axial (f) image.
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F1
Interestingly, the frontal convexity mass lesion was invading the frontal sinus [Figure 1a-d]. Postoperative imaging showed operative changes in the frontal convexity region and the residual sellar mass lesion [Figure 1e and f].
(a and b) Hematoxylin and eosin (H&E) staining, x10, shows sheets of monomorphic cells with round nuclei, salt and pepper chromatin consistent with pituitary adenoma (c). H&E, x10, whorl, suggestive of meningioma confirmed with immunohistochemistry (IHC) (d). IHC for vimentin, x4 and (e). IHC for EMA, x4.
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F2
Histopathological evaluation revealed frontal lobe lesion - metaplastic meningioma and suprasellar tumor - PA [Figure 2].