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Washington University Experience | NEOPLASM (SELLAR) | Pituitary Adenoma - Pituitary Neuroendocrine Neoplasm | MRI | 3A0 Case 3 History
Case 3 History ---- The patient is a 53-year-old man with past medical history significant for hypogonadism. Recently, he awoke with headache, which persisted. Head CT at an outside institution showed a pituitary mass. MRI performed at BJH shows a ~3.7 cm solid and cystic mass expanding the sella, invading the right cavernous sinus, abutting the left cavernous sinus, and showing mass effect on the optic chiasm. Radiological impression: Consistent with pituitary macroadenoma. Laboratory studies show: normal levels of GH, Insulin-like Growth Factor, and TSH; reduced levels of PRL, LH, FSH, free T4; and mildly elevated ACTH (85.4 [7.0 to 63]), with normal cortisol. Operative procedure: Endoscopic transsphenoidal hypophysotomy for tumor resection, with intraoperative MRI. ---- Immunohistochemistry shows the neoplastic cells are diffusely positive for ACTH (plasma membrane distribution), synaptophysin (cytoplasmic), and cytokeratin (CAM 5.2; variably cytoplasmic or paranuclear/Golgi, without evidence of Crooke's cell change). The tumor tissue is negative for TTF-1, GH, prolactin, FSH, LH, and TSH.
