case_images: PMC4748791_01
case_images: Axial MRI (a) of the brain demonstrates an enhancing lesion in the sella turcica and suprasellar space with extension to the left side of the sella and along the tentorium. Coronal (b) and sagittal (c) Gd-enhanced T1-weighted images demonstrate the lesion extending into the suprasellar space abutting the optic chiasm. The mass extends into the cavernous sinuses bilaterally with encasement of the bilateral cavernous carotid arteries. It also extends inferiorly on the left side into Meckel's cave.
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case_images: PMC4748791_01_cro-0009-0025-g01.jpg
case_images: F1
case_images: Magnetic resonance imaging (MRI) revealed an aggressive appearing lesion within the sella turcica involving the cavernous sinuses bilaterally (fig. 1a). Superiorly, the suprasellar extension of the tumor did not involve the optic chiasm, but was abutting the optic nerves (fig. 1b, c).
case_images: Photomicrographs of tumor sections with H&E staining (a) and immunohistochemical staining with CD20 (b). a Monotonous lymphoid cells, which have irregular hyperchromatic nuclei with irregular nuclear contours, displace nests of pituitary cells. b The tumor cells stained positive for immunohistochemical staining with CD20, demonstrating that they are a clonal proliferation of B cells.
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case_images: PMC4748791_01_cro-0009-0025-g02.jpg
case_images: F2
case_images: MCL. Microscopy of the pituitary mass showed atypical lymphocytes in diffuse sheets infiltrating into the pituitary gland (fig. 2a). The tumor cells stained positive for the immunohistochemical stain CD20, demonstrating that the tumor cells were a clonal proliferation of B cells (fig. 2b).
case_images: Follow-up axial and coronal MR imaging at 3 months (a, b) and 6 months (c, d) post-surgery, chemotherapy, and radiation therapy demonstrate decreased size of the sellar mass, suggesting response to the treatment regimen.
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case_images: PMC4748791_01_cro-0009-0025-g03.jpg
case_images: F3
case_images: Follow-up MRI of the brain was obtained demonstrating decreased size of the patient's pituitary tumor at both 3 and 6 months (fig. 3).