PMC4738724_01
Preoperative computed tomography angiogram (CTA) scan, sagittal bone window (a) and coronal vascular window (b) sections, showing poorly vascularized clival mass that erodes the clivus (a) and encases the right internal carotid artery (b).
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Repeat magnetic resonance imaging (MRI) revealed an enhancing lesion measuring 1.7 x 2.6 x 3.2 cm that involved the entire clivus, extended laterally to the petroclival junction, and invaded the cavernous sinuses bilaterally with further encasement of the internal carotid arteries (ICAs) bilaterally, without direct extension into the sella (Figures 1(a)-1(b) and 2(a)-2(c)).
Postoperative magnetic resonance imaging, with contrast, axial (a) and sagittal (b) sections, demonstrating a small amount of residual tumor.
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ICA (Figures 3(a) and 3(b)). Immunostaining of the tumor tissue demonstrated an epithelial neoplasm that stained positive for synaptophysin and prolactin with a low Ki-67 index (Figures 4(a)-4(d)), suggestive of a prolactin-secreting pituitary adenoma.
Pathologic evaluation, all at 20x magnification. (a) Histologic sections demonstrate an epithelial neoplasm composed of monomorphic cells with increased nuclear to cytoplasmic ratios and prominent nucleoli. (b) Immunohistochemical staining positive for synaptophysin. (c) Prolactin diffusely and strongly labels the neoplastic cells. (d) The proliferation index is approximately 2% on Ki-67 staining.
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ICA (Figures 3(a) and 3(b)). Immunostaining of the tumor tissue demonstrated an epithelial neoplasm that stained positive for synaptophysin and prolactin with a low Ki-67 index (Figures 4(a)-4(d)), suggestive of a prolactin-secreting pituitary adenoma.