PMC10413133_01
An emergency CT examination performed 3 days after COVID-19 vaccination showed a hyperdense suprasellar mass lesion in the upper part of the known pituitary tumor, suggesting pituitary apoplexy. (A) Axial section. (B) Coronal section. (C) Sagittal section.
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F1
A 45-year-old male was referred to our hospital with the chief complaints of bitemporal hemianopsia and vision loss (visual acuity, left: 0.04, right: 0.03) (Supplementary Figure S1). Emergency computed tomography (CT) results showed a hyperdense suprasellar mass lesion in the upper part of the known pituitary tumor (Figure 1).
Images obtained during endoscopic endonasal surgery. (A) A tumor with hematoma was debulked in a piecemeal manner. (B) The arachnoid membrane on the left side of the diaphragm was exposed. (C) Compression of the pituitary gland was observed on the left side with the patient in a superior position. (D) The hard tumor was intentionally left in place. T, tumor; A, arachnoid; P, pituitary gland.
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F2
Brain magnetic resonance imaging (MRI) revealed a giant pituitary tumor which was compressing to optic apparatus and bilateral basal ganglia (Supplementary Figure S2), while endocrine findings obtained at that time showed no evidence of a functional pituitary neuroendocrine tumor (Supplementary Table S1). Intraoperative findings revealed an intrasellar mass lesion that formed a relatively soft tumor similar to an ordinary pituitary neuroendocrine tumor (Figure 2A). Following resection of the intrasellar mass, the arachnoid membrane on the left side of the diaphragm was exposed (Figure 2B), which revealed compression of the pituitary gland on the superior left side (Figure 2C). The hard tumor was intentionally left, as removal was considered to be dangerous and could potentially cause damage to the neurovascular structure (Figure 2D).
Histopathologic analysis led to a diagnosis of pituitary neuroendocrine tumor. The findings showed tumor cells with eosinophilic cytoplasm (white arrow) invaded by lymphocytes (white arrowhead) and red blood cells suggesting pituitary apoplexy. Hematoxylin and eosin staining; original magnification x100.
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F3
Based on histopathology results, the diagnosis was pituitary neuroendocrine tumor (Figure 3). The findings showed tumor cells with eosinophilic cytoplasm (white arrow) invaded by lymphocytes (white arrowhead) and red blood cells suggesting pituitary apoplexy (Figure 3). However, as compared to visual function status findings before apoplexy development, visual acuity and visual field impairment in the right eye had worsened (visual acuity, right: 0.01) (Supplementary Figure S3).
Postoperative head CT showed the residual tumor with hematoma in the suprasellar region. (A) Axial section. (B) Coronal section. (C) Sagittal section.
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F4
Postoperative CT findings showed the residual tumor with hematoma in the suprasellar region (Figure 4). Five months later, brain MRI results showed tumor shrinkage because of natural hematoma absorption and decompression of the optic apparatus (Supplementary Figure S4).