PMC5894005_01
(A, B) T2W sagittal and coronal images (A, B) showed a well-defined, heterogeneously hypointense enlargement (7.8x7.9 mm) of the anterior pituitary lobe (arrow). (C, D) Postcontrast coronal and sagittal images (C, D) showing intense, peripheral enhancement of the pituitary gland; however, the centre of the lesion was non-enhancing resulting in solid-cystic appearance. The pituitary stalk was also thickened and intensely enhancing (arrow in D); nonetheless, it was maintained in the midline. There was indentation on the optic chiasma (curved arrow in C); although there were no visual complaints.
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For further evaluation and delineation of its extent, MRI was performed (Figure 1A-1D).
Serial MRI scans of the sella over 6 years, postcontrast (except G and H) coronal (top row) and sagittal images (bottom row) for comparative analysis. At initial presentation (A, B), the anterior lobe of the pituitary gland was enlarged with a solid-cystic appearance (arrow in A). Pituitary stalk was also thickened (arrow in B). At 4 weeks (C, D), a significant reduction in the size of the lesion (arrow in C) and thickness of the pituitary stalk are seen (arrow in D). (E, F) At 10 weeks, a near-complete disappearance of the mass with persistence of a tiny cystic remnant is seen (arrow in E). The height of the pituitary gland was also decreased with a flattened upper margin (arrow in F), unusual for a multipara. (G, H) At 6 years, a partial empty sella, thinned pituitary stalk (arrow in G, H) and absence of lesion were noted.
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There was no cavernous sinus invasion, encasement of the internal carotid or extracranial extension (Figure 2A, 2B). After 4 weeks, there was a remarkable clinical improvement and significant reduction in the overall size of the mass on MRI (Figure 2C, 2D). After 10 weeks, follow-up MRI (Figure 2E, 2F) revealed near-complete resolution of the lesion with persistence of only a small cystic remnant. A recent MRI scan, performed after 6 years, revealed a partially empty sella with complete disappearance of the pituitary lesion (Figure 2G, 2H).