PMC9880149_01
MRI (A,B,E,F) and CT (C,D) findings in a patient with pituitary adenoma (PA) and concurrent malignant triton tumor (MTT) in sellar area. On 20 days before the operation, axial image (A) and saggittal (B) T2-weighted images revealed that the lesion is consisted of two distinctive components with a clear border. The upper and lower components were histologically diagnosed as pituitary adenoma and MTT (red asterisk), respectively. Four days after the operation, axial (C) and saggittal (D) CT images showed that MTT component was totally removed, while residual PA could be seen in suprasellar area. Fifty-six days after the operation, axial (E) and saggittal (F) contrast-enhanced MR images revealed that MTT has recurred.
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F1
Intracranial MRI revealed an irregular mass with 2 distinctive components in sellar area (Figures 1A,B). On the fourth day after the operation, computer tomography (CT) examination of the brain revealed that the tumor mass containing MTT component in sphenoidal sinus was gross-totally resected, while the pituitary adenoma was partially resected with residual tumor in the suprasellar area (Figures 1C,D). A re-examination of cranial MRI 56 days after the operation showed that the residual tumor had grown again (Figures 1E,F).
Hematoxylin and eosin (HE) and immunohistochemical stainings in a patient with pituitary adenoma (PA) (A-F) and concurrent intracraninal malignant triton tumor (MTT) (x400) (G-L). HE (A) and immunoreactivity of synaptophysin (Syn) (B), chromogranin A (CgA) (C), follicle-stimulating hormone (FSH) (D), somatostatin receptor 2 (SSTR2) (E), and cytokeratin (CK) (F) supported the diagnosis of PA. Round and fussiform cells with eosinophilic cytoplasm morphologically consistent with rhabdoid differentiation were observed in HE staining (G). Desmin (H), Myogenin (I), and myogenic differentiation 1 (MyoD1) (J) immunoreactivity supported the diagnosis of a MTT. Notably, TTF-1 (K) was immunopositive, while CK (L) was immunonegative in the MTT.
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F2
Pathological findings revealed that the tumor was composed of a pituitary adenoma (Figures 2A-F) in the upper area and a concurrent MTT in the lower area with a clear border (Figures 2G-L). Interestingly, TTF-1, which could be found in 66.7% of schwannomas and is also a novel marker of pituitary tumors of the posterior lobe, was immunoreactive (Figures 2H).