case_images: PMC9437488_01
case_images: Pathological sections of case 2. (A) HE staining of tumor (red arrows indicate typical Crooke's hyaline change). (B, C) Immunostaining of ACTH, T-PIT, and CK8/18
  (D) green and yellow arrows show a round and semi-circular immunostaining of keratin, respectively). Original magnification, 40x.
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case_images: f3
case_images: Table 2 ). The patient underwent transsphenoidal surgery in July 2020, and the postoperative pathology suggested a CCA with CK8/18 > 50% ( Figure 3 ), T-PIT (+), and Ki-67 about 3%.
case_images: Imaging data of case 2. The images show coronal and sagittal MRI of the patient's head preoperatively (A, B), three months postoperatively (C, D), and twenty-one months postoperatively (E, F), respectively.
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case_images: PMC9437488_01_fendo-13-947085-g004.jpg
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case_images: However, MRI after 4 months suggested a mass in the operative area, measuring approximately 15x18x14 mm ( Figure 4 ).
case_images: Immunostaining results of case 3. (A) HE staining of tumor tissue (red arrows indicate typical Crooke's hyaline change). (B, C) Immunohistochemical staining for ACTH and T-PIT. (D) Immunohistochemical staining of cells keratin (green and yellow arrows show a round and semi-circular immunostaining of CK8/18, respectively). Original magnification, 40x.
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case_images: PMC9437488_01_fendo-13-947085-g005.jpg
case_images: f5
case_images: The patient underwent microsurgery in October 2021, following which the elevated ACTH was relieved ( Table 2 ), and the pathology suggested cyclic CK8/18 staining of about 80% ( Figure 5 ), Ki-67 of about 10%, and infiltration of Crooke cells were observed in bone trabeculae.
case_images: MRI examination of case 3. The images show coronal and sagittal MRI of the patient's head preoperatively (A, B), one week postoperatively (C, D), and three months postoperatively (E, F), respectively.
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case_images: PMC9437488_01_fendo-13-947085-g006.jpg
case_images: f6
case_images: Hematology and MRI in January 2022 showed no evidence of recurrence ( Figure 6 ).
case_images: PMC9437488_02
case_images: Histopathological staining of case 4. (A) HE staining of tumor tissue (red arrows indicate typical Crooke's hyaline change). (B, C) Immunohistochemical staining for ACTH and T-PIT. (D) Immunostaining of CK8/18 (green and yellow arrows show a round and semi-circular pattern, respectively). Original magnification, 40x.
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case_images: PMC9437488_02_fendo-13-947085-g007.jpg
case_images: f7
case_images: Transsphenoidal surgery was performed, and the pathology suggested that the tumor tissue was T-PIT (+), ACTH positive >95%, Crooke cells accounted for about 80% ( Figure 7 ), and Ki-67 about 1% (+).
case_images: Imaging examination of case 4. The images show coronal and sagittal MRI of the patient's head preoperatively (A, B), one week postoperatively (C, D), and three months postoperatively (E, F), respectively.
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case_images: PMC9437488_02_fendo-13-947085-g008.jpg
case_images: f8
case_images: However, recent imaging data suggested a suspicious residual tumor ( Figure 8 ).