PMC9107939_01
Perioperative image studies.
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Preoperative computed tomography of the bone window shows the dorsum sellae enlarged into the sellae turcica. (A) The lesion shows hypointensity on T1-weighted magnetic resonance imaging (MRI) (B) and mixed intensity on T2-weighted MRI. (C) The normal pituitary gland seems to be compressed to the left frontal side by the tumor. The lesion is well enhanced on gadolinium-enhanced MRI (D, E, F).
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Postoperative gadolinium-enhanced MRI showed no residual tumor, and the pituitary gland remained normal (G, H, I).
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The lesion was highly calcified and vascularized (Fig. 1A-F). The tumor was thought to have been completely resected (Fig. 1G-I).
Intraoperative findings.
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A. View just after opening of the frontal wall of the sphenoid sinus. Vascular collection and dilatation of the sphenoid sinus mucosa (blue circle).
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B. View after removal of the sphenoid sinus mucosa. Highly thickened sphenoidal bone inferior to the sellar floor (blue circle). The most reddish part inferior to the sellae was the abnormal bone structure (black arrowhead).
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C. View after cutting the dura mater of the sellar floor. The blue dotted line shows the cutting edge of the dura mater. The rigid membrane appeared to be the dura mater (green arrow) separating the tumor (inferior and lateral to the membrane) and the normal pituitary gland (superior and medial to the membrane).
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D. View after opening the cavernous sinus medial wall. The tumor adhered to the medial wall (purple circle). The internal carotid artery (yellow arrow) was identified.
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Intraoperatively, the bone around the right cavernous and clival portions of the internal carotid artery were highly thickened (Fig. 2A, B). The tumor and normal pituitary gland were divided by a membrane that seemed to be the dura mater (Fig. 2C). After removal of the medial wall, no residual tumor was observed in the cavernous sinus (Fig. 2D).
Microscopic and immunohistochemical findings of the tumor.
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Micrographs of the extraosseous fraction of the lesion showing numerous small vascular structures with swollen endothelial cells (hematoxylin eosin [HE] staining; original magnification, x100 (A), x400 (B)). Intraosseous fraction showing numerous thin-walled vessels occupying the trabecular bone (HE original magnification, x400 (C)). Immunohistochemical analysis showing the tumor was negative for (D) epithelial membrane antigen (EMA original magnification, x400) but positive for (E) cluster of differentiation (CD) 31 (original magnification, x400) and (F) CD34 (original magnification, x400).
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Immunohistochemical staining revealed that test results for cluster of differentiation (CD) 31 and CD34 were mostly positive, but those for epithelial membrane antigen and glial fibrillary acidic protein were negative (Fig. 3).