Answer for CoW 05 Nov 2017
INVASIVE PITUITARY MACROADENOMA
Findings
E/o large heterogeneously enhancing heterointense predominantly isointense mass lesion noted arising the from the sellar region with extension into supra and parasellar region predominantly on the right side with encasement of right internal carotid artery and mass effect over the optic chiasma and right medial temporal lobe with infiltration into the clivus and retroclival region with compressive effect over the pons noted. Pituitary gland not separately visualised.
Discussion
Pituitary macroadenomas are the most common suprasellar mass in adults. They are defined as pituitary adenomas greater than 10 mm in size and are approximately twice as common as pituitary microadenomas. On imaging they usually present as a solid tumour with an attenuation similar to brain (30-40 HU) and demonstrates moderate contrast enhancement. The same is observed on MRI, where they are isointense to the grey matter both on T1 and T2-weighted images. However attenuation and signal characteristics can significantly vary depending on tumour components such as haemorrhage, cystic transformation or necrosis. On follow up, our patient has undergone Trans-sphenoidal hypophysectomy with parasellar component removal by craniectomy. HPE Proven : INVASIVE PITUITARY MACROADENOMA DIFFERENTIALS: Craniopharyngioma (Papillary type), Metastasis, Meningioma, Chordoma.
References: 1. Aggressive Pituitary Tumors -Eleftherios Chatzellis Krystallenia I. Alexandraki Ioannis I. Androulakis Gregory Kaltsas 2. Grainger & Allison’s Diagnostic Radiology. 3. Osborn’s Brain Imaging
Findings
E/o large heterogeneously enhancing heterointense predominantly isointense mass lesion noted arising the from the sellar region with extension into supra and parasellar region predominantly on the right side with encasement of right internal carotid artery and mass effect over the optic chiasma and right medial temporal lobe with infiltration into the clivus and retroclival region with compressive effect over the pons noted. Pituitary gland not separately visualised.
Discussion
Pituitary macroadenomas are the most common suprasellar mass in adults. They are defined as pituitary adenomas greater than 10 mm in size and are approximately twice as common as pituitary microadenomas. On imaging they usually present as a solid tumour with an attenuation similar to brain (30-40 HU) and demonstrates moderate contrast enhancement. The same is observed on MRI, where they are isointense to the grey matter both on T1 and T2-weighted images. However attenuation and signal characteristics can significantly vary depending on tumour components such as haemorrhage, cystic transformation or necrosis. On follow up, our patient has undergone Trans-sphenoidal hypophysectomy with parasellar component removal by craniectomy. HPE Proven : INVASIVE PITUITARY MACROADENOMA DIFFERENTIALS: Craniopharyngioma (Papillary type), Metastasis, Meningioma, Chordoma.
References: 1. Aggressive Pituitary Tumors -Eleftherios Chatzellis Krystallenia I. Alexandraki Ioannis I. Androulakis Gregory Kaltsas 2. Grainger & Allison’s Diagnostic Radiology. 3. Osborn’s Brain Imaging
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!