PMC4335346_01
(A and B) MRI image of patient 1 demonstrating the pituitary lesion pre-surgery.
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Cranial magnetic resonance imaging (MRI) revealed a suprasellar mass compressing the optic chiasm with a relatively uniform high-signal intensity on T1- and T2-weighted sequences (Fig. 1A and B).
(A and B) MRI image of patient 3 demonstrating the pituitary lesion post-surgery.
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No well-formed granuloma was observed although loose areas of epithelial macrophage aggregates were present in a vaguely granulomatous manner and occasional multinucleate giant cells, partly foamy (Touton-like), were observed (Fig. 4D, E and F). There were also xanthomatous and multinucleate macrophages, but without well-formed granuloma (Fig. 4G and H).
PMC4335346_02
(A) Patient 1. Haematoxylin and eosin-stained section showing numerous cholesterol clefts (arrowheads). Brown, haemosiderin pigment is present (arrow) and there is an area of necrosis (star). Scale bar, 100 mum. (B and C) Patient 2. In addition to cholesterol clefts, there is an aggregate of multinucleate giant cells (arrow, B). In C, the cholesterol clefts are associated with new fibrosis. Scale bars, 100 mum. (D, E and F) Patient 3, first biopsy. An area of lymphoplasmacytic cells surrounded by paler macrophages, with a loose, vague granulomatous appearance (D, scale bar, 100 mum). In areas, foamy macrophages are admixed with neutrophils (E, scale bar, 50 mum), while F shows a somewhat foamy multinucleate macrophage (arrow) in a background of lymphocytes, histiocytes and plasma cells (scale bar, 50 mum). (G and H) Patient 3, second biopsy. Low-power view (G) showing dense fibrous tissues with a lymphoplasmacytic infiltrate. There is an area of necrosis towards the top of the field (scale bar, 100 mum). At high power (H), there is a prominent foamy macrophage infiltrate with admixed lymphocytes and histiocytes.
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Cranial MRI scan revealed an 18x14x19 mm pituitary lesion, with suprasellar extension and superior displacement of the optic chiasm (Fig. 2A and B). An MRI scan performed 6 months following surgery demonstrated normal pituitary gland, stalk and chiasm with no residual lesion (Fig. 2C).
(A and B) MRI image of patient 3 demonstrating the pituitary lesion post-surgery.
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fig3
No well-formed granuloma was observed although loose areas of epithelial macrophage aggregates were present in a vaguely granulomatous manner and occasional multinucleate giant cells, partly foamy (Touton-like), were observed (Fig. 4D, E and F). There were also xanthomatous and multinucleate macrophages, but without well-formed granuloma (Fig. 4G and H).
PMC4335346_03
(A and B) MRI image of patient 2 demonstrating the pituitary lesion pre-surgery. (C) MRI image of patient 2 demonstrating the pituitary lesion post-surgery.
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fig2
Persistence of severe right temporal and orbital pain for a year led to further transsphenoidal surgery; the histology findings showed a dense inflammatory infiltrate of lymphocytes, plasma cells and histiocytes, with scattered polymorphs (Fig. 3A and B).
(A and B) MRI image of patient 3 demonstrating the pituitary lesion post-surgery.
edmcr-2015-140089-g003.jpg
PMC4335346_03_edmcr-2015-140089-g003.jpg
fig3
No well-formed granuloma was observed although loose areas of epithelial macrophage aggregates were present in a vaguely granulomatous manner and occasional multinucleate giant cells, partly foamy (Touton-like), were observed (Fig. 4D, E and F). There were also xanthomatous and multinucleate macrophages, but without well-formed granuloma (Fig. 4G and H).