PMC5473081_01
(a) Preoperative magnetic resonance (MRI) coronal T2-weighted imaging demonstrating sellar/suprasellar mass (diameter of 2 cm) with a heterogeneous signal, mainly hyperintense, compressing the optic chiasm and extended laterally toward the left cavernous sinus. (b and c) Preoperative magnetic resonance coronal and sagittal contrast-enhanced T1-weighted imaging showing an intense and diffuse enhancement. (d-f) MRI imaging performed 2 years before showing normal pituitary/sellar signal (white arrow), the frontal arachnoid cyst and left vestibular schwannoma
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T1-weighted images (WI) and hyperintense on T2-WI [Figure 1a]. The images showed diffuse homogeneous enhancement following contrast administration [Figure 1b and c]. Interestingly, an MRI examination performed 2 years before, for follow-up after radiosurgery for vestibular schwannoma and frontal arachnoid cyst, demonstrated a normal pituitary gland [Figure 1d-f].
(a) Intraoperative endoscopic picture depicting that the upper part of the lesion (black arrow) presented clear infiltration of the optic chiasm (asterisk) without a safe plane of cleavage. (b) Hematoxylin-eosin (H and E) staining demonstrates cells with scant cytoplasm and nuclei with speckled chromatin. Mitotic activity was present and vigorous (magnification x20). (c and d) Cells are positive for (c) cytokeratin Cam 5.2. (magnification, x20) and (d) synaptophysin (magnification, x20)
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Moreover, the upper part of the lesion presented clear infiltration of the optic chiasm without a safe plane of cleavage [Figure 2a]. There was no evidence of necrosis [Figure 2b]. Tumor cells stained with antibodies to cytokeratin Cam 5.2. [Figure 2c], synaptophysin [Figure 2d], and chromogranin.
(a-d) Postoperative and follow-up at 12, 24 and 48 months, coronal MRI pictures depicting the stability of residual disease
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Subsequent postoperative CT and MRI [Figure 3a] demonstrated the presence of an abnormal signal toward the cavernous sinus and suprasellar area, which was consistent with residual disease. Follow-up MRI studies at 12, 24, and 48 months were performed [Figure 3b-d] showing the stability of the residual mass in the sellar region.