case_images: PMC4960927_01
case_images: Computed tomography of the brain showing subarachnoid chemorrhage with a central low density (a). No substantial sellar enlargement is observed with a sagittal reconstructed view (b). Brain computed tomography angiography showing the absence of a ruptured aneurysm (c). Computed tomography obtained 7 days postoperatively showing extensive cerebral infarction due to vasospasm (d)
case_images: SNI-7-459-g001.jpg
case_images: PMC4960927_01_SNI-7-459-g001.jpg
case_images: F1
case_images: Brain computed tomography (CT) revealed a diffuse SAH with a central low density [Figure 1a], and on the sagittal reconstructed view, no enlargement of the sella turcica was observed [Figure 1b]. There were no brain aneurysms on the brain CT angiography [Figure 1c], and thus, brain magnetic resonance imaging with gadolinium was subsequently performed. Despite transient mild improvement in the consciousness level following surgery, the patient sustained a large cortical infarction secondary to the vasospasm [Figure 1d].
case_images: Magnetic resonance imaging showing an intrasellar mass which is depicted as low-intensity on a nonenhanced T1-weighted image (a). With gadolinium, the mass exhibits strong enhancement (b, sagittal view; c, axial view). On a T2-weighted image, the mass is depicted as heterogeneous high intensity, and a dense subarachnoid clot was also observed in the prepontine cistern (d)
case_images: SNI-7-459-g002.jpg
case_images: PMC4960927_01_SNI-7-459-g002.jpg
case_images: F2
case_images: The intrasellar mass was depicted as a low-intensity signal on nonenhanced T1-weighted sequence [Figure 2a], with strong, heterogeneous contrast enhancement after gadolinium administration [Figure 2b and c], and the posterior pituitary lobe appeared to have been displaced posteroinferiorly by the tumor. On a T2-weighted image, the mass is depicted as heterogeneous high intensity, and a dense subarachnoid clot was also observed in the prepontine cistern [Figure 2d].
case_images: On H and E staining, the tumor cells are seen to have proliferated densely, either in a medullary or trabecular pattern, and densely arranged tumor cells with large, irregular nuclei and many mitotic figures are observed (a). In another area, tumor invasion to the venous wall is observed (b). Although an extensive immunohistochemical study was performed to identify the histological origin of the tumor, it is positive only for vimentin (c) and p53. The MIB-1 labeling index is 63.6%, indicating potent proliferative activity of the tumor (d)
case_images: SNI-7-459-g003.jpg
case_images: PMC4960927_01_SNI-7-459-g003.jpg
case_images: F3
case_images: Densely arranged tumor cells with large, irregular nuclei and many mitotic figures were observed [Figure 3a]. In another area of the specimen, tumor invasion into the venous wall was observed [Figure 3b]. The tumor was negative for the majority of epithelial, neuroendocrine, glial cell, germ cell, lymphocytic, and mesenchymal markers [Table 1] and was positive only for vimentin [Figure 3c] and p53. The MIB-1 labeling index was 63.6%, indicating potent proliferative activity of the tumor [Figure 3d].