PMC7700073_01
T1-weighted MRI with gadolinium contrast of the metastatic lesion. At presentation, coronal (A) and sagittal (B) views showing expanded sella with thick-walled sellar/suprasellar mass with extension into the right sphenoid sinus, dorsum sellae, and clivus. At one month after resection, coronal (C) and sagittal (D) views showing recurrence and of the enhancing mass centered in the sphenoid sinus with locoregional involvement, new bulging into the right cavernous sinus and involvement of right Dorello's canal. At three months after resection, coronal (E) and sagittal (F) views showing significant increase in size of the mass. The lesion involved the sphenoid sinus and posterior ethmoid air cells, elevating the sellar floor and displacing the pituitary gland superiorly. The lesion extended to the cavernous sinus and abutted the cavernous carotid arteries, with erosion of the posterior cortex of the clivus, mild retroclival extension with dural involvement, and partial encasement of the basilar artery.
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Magnetic resonance imaging (MRI) of the brain and orbits revealed a 2.2 x 3.0 x 2.5 cm sellar/suprasellar mass with internal cystic necrotic component and abutment of the cavernous sinuses (Figure 1A and B). An MRI at that time revealed recurrence of a mass centered in the sphenoid sinus with new bulging into the right cavernous sinus and involvement of right Dorello's canal (Figure 1C and D). At 13 weeks after resection, MRI of the brain revealed an interval increase in size of the clival lesion with further invasion of the cavernous sinus and dural extension (Figure 1E and F).