case_images: PMC6187963_01
case_images: T1-weighted sagittal magnetic resonance imaging images with contrast enhancement. (a) The image was obtained at the time of diagnosis of panhypopituitarism, showing the pituitary stalk thickening (white arrowhead). (b) Image after 6 months showed that the lesion at the hypothalamus was enlarged (white arrowhead)
case_images: SNI-9-197-g001.jpg
case_images: PMC6187963_01_SNI-9-197-g001.jpg
case_images: F1
case_images: T1-weighted magnetic resonance imaging (MRI) showed thickening of the pituitary stalk and disappearance of hyperintensity in the posterior lobe of the pituitary gland [Figure 1a]. After 6 months, the mass lesion in the hypothalamus had clearly enlarged; she was referred to our department for biopsy of the lesion for definitive diagnosis [Figure 1b].
case_images: T1-weighted magnetic resonance imaging images with contrast enhancement. (a) Axial image showed that new multiple enhanced lesions were present at the basal ganglia (white arrowhead) and deep white matter in the frontal lobe (white arrow). (b) Coronal image showed that the lesion at the hypothalamus had progressed (black arrowhead), and there were some enhanced lesions surrounding the hypothalamus (white arrowhead)
case_images: SNI-9-197-g002.jpg
case_images: PMC6187963_01_SNI-9-197-g002.jpg
case_images: F2
case_images: After another 5 months, follow-up MRI revealed that the lesion in the hypothalamus had further enlarged and new, multiple enhanced lesions were detected in the basal ganglia and white matter [Figure 2a and b].
case_images: Histopathological findings of surgical specimen. (a) Hematoxylin and eosin staining showed highly present fibrosis and inflammatory cells invasion. (b) Immunoreactivity for CD1a, which is definitive marker of dendritic cell, was found. Positivity for CD68 (c), CD8 (d), and CD20 (e) was indicative of the presence of macrophages, T lymphocytes and B lymphocytes, respectively. (f) Immunoreactivity for glial fibrillary acidic protein, a marker for nerve fibers was strongly positive
case_images: SNI-9-197-g003.jpg
case_images: PMC6187963_01_SNI-9-197-g003.jpg
case_images: F3
case_images: Histopathological examination of the surgical specimens showed remarkable invasion of several types of inflammatory cells with fibrosis [Figure 3a]. T lymphocytes, and B lymphocytes, respectively [Figure 3c-e]. There was also immunoreactivity for glial fibrillary acidic protein, which marks a response for reactive astrocytes [Figure 3f].
case_images: T1-weighted coronal magnetic resonance imaging images with contrast enhancement. (a) Before steroid administration, there were enhanced lesions at the hypothalamus (white arrow) and the cerebral parenchyma (white arrowheads). (b) Eighteen months after administration of steroid, the enhanced lesion at the hypothalamus was reduced (white arrow), and the lesions at the brain parenchyma were completely diminished
case_images: SNI-9-197-g004.jpg
case_images: PMC6187963_01_SNI-9-197-g004.jpg
case_images: F4
case_images: Steroid treatment was gradually decreased, and no recurrence has been observed 18 months postoperatively [Figure 4a and b].