PMC3162801_01
(a and b) Magnetic resonance images of the T1-weighted image with contrast demonstrated enhancing suprasellar mass. (c and d) Recurrent tumor. (e and f) Postoperative magnetic resonance images showed debulked tumor
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F1
The MRI scan revealed a suprasellar lesion with the compression of the optic nerves [Figure 1a and b]. The MRI showed a 2.7 x 2.4 x 2.8 cm enhancing suprasellar mass compressing the optic nerve ventrally without hydrocephalus, which had increased in size compared to the postoperative scan [Figure 1c and d]. Visual acuity improved postoperatively and a significant reduction in the tumor bulk was seen on the postoperative MRI scan [Figure 1e and f].
Histopathologic findings for patient 1 (original magnification, x400). These images are from the patient's third resection. Microscopic evaluation reveals interlacing fascicles of spindled to epithelioid cells with eosinophilic, variably oncocytic cytoplasm. Mild to moderate nuclear atypia is present. (a) Mitotic figures are rare. Immunostains for (b) transcription factor 1, (c) epithelial membrane antigen, (d) and mitochondria are positive
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F2
Mitotic figures were rare [Figure 2a]. The immunostain showed positivity for TTF-1, EMA, mitochondria [Figure 2b-d], S-100, and galectin-3, and was negative for CD34 and CD68.
PMC3162801_02
(a and b) Magnetic resonance images of the T1-weighted image with contrast demonstrated enhancing suprasellar mass. (c and d) Postoperative magnetic resonance images showed no residual tumor
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F3
An MRI scan revealed a giant suprasellar clival lesion with the distortion of the chiasm and invasion of the clivus [Figure 3a and b]. Visual acuity improved postoperatively and a postoperative MRI scan revealed no residudal tumor [Figure 3c and d].
Histopathologic findings for patient 2 (original magnification of both, x400). Microscopic examination reveals a solid neoplasm composed of elongate, bipolar spindle cells arranged in interlacing fascicles or in a storiform pattern. Individual tumor cells contain abundant eosinophilic cytoplasm and cell shapes range from short and plump to elongate and angulated. There is no significant cytoplasmic granularity or vacuolization. (a) Mitotic figures are rare. (b) Immunostain for transcription factor 1 is positive
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F4
Mitotic figures were rare [Figure 4a]. GFAP, CD34, CD57, and CD68, and only focally positive for mitochondria. Given the histology, location, and immunostaining pattern, the most likely pathologic diagnosis was pituicytoma [Figure 4].