PMC9479509_01
Contrast-enhanced computed tomography whole abdomen (a) demonstrating multiple hypoenhancing lesions of various sizes noted in the right, left, and caudate lobes of liver. Magnetic resonance imaging brain - sagittal (b) and axial (c) images demonstrating low signal intensity lesions involving the sellar-suprasellar region.
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F1
A 60-year-old woman who was a diagnosed and treated case of PA on follow-up underwent a screening contrast-enhanced computed tomography of the whole abdomen 6 weeks post-surgery which revealed multiple well-defined hypoechoic lesions of varying size involving right, left, and caudate lobes of liver with largest lesion measuring 7.0 x 7.0 cm in size, with few showing areas of central necrosis [Figure 1a]. The previous history revealed that she underwent transnasal and transsphenoidal resection of an infiltrating sellar-suprasellar tumor (2.4 x 2.3 x 1.7 mm) at another institution 6 weeks back; however, resection was incomplete as tumor was invading the cavernous sinus [Figure 1b and c].
Cytomorphological characteristics of the liver lesion (a-c) singly dispersed monotonous population of tumor cells (a), microacinar arrangement with cells exhibiting mild nuclear pleomorphism, stippled chromatin, and eccentric nuclei (b and c). Histopathology of pituitary lesion showing highly cellular sheets and nests of monotonous cells with intervening fibrovascular septae (d), positive expression for synaptophysin (e), chromogranin (f), Ki67 >3% (g), and increased expression for p53 (h). (Original magnifications, a: H&E; 200x, b: H&E; 400x, c: PAP; 400x, d: H&E; 200x, e-h: DAB; 200x).
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F2
Cytosmears showed loose clusters and microacini of monotonous, small- to medium-sized plasmacytoid cells with moderate amphophilic cytoplasm, mildly pleomorphic, round to oval eccentrically placed nuclei, coarsely granular chromatin, and inconspicuous to prominent nucleoli [Figure 2a-c]. Review of previous sellar tumor biopsy revealed sheets and nests of monomorphic cells with similar morphology as seen in cytosmears [Figure 2d]. Immunohistochemical stains for synaptophysin and chromogranin were positive [Figure 2e and f] and all pituitary hormones including growth hormone, adrenocorticotropic hormone, PRL, and thyroid-stimulating hormone were tested and showed negative expression. Ki-67 labeling index was >3% and p53 showed wild-type expression [Figure 2g and h].