case_images: PMC10955116_01
case_images: Imaging of MRI and CT. T1-weighted sagittal (A) and coronal (B) magnetic resonance imaging reveal a mildly enhancing nasopharyngeal nodule (red arrow) and normal pituitary (yellow arrow). Computed tomography (C) shows a nasopharyngeal soft tissue nodule.
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case_images: Surprisingly, a mass measuring approximately 13 mm x 11 mm was discovered in the nasopharynx on the pituitary MRI, which is consistent with the nasopharyngeal soft tissue nodule presented on paranasal sinus computed tomography (CT) ( Figure 1 ).
case_images: Imaging of 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT. There is a soft tissue nodule at the apex of the nasopharynx with 68Ga-DOTATATE (A) and 18F-FDG (B) intense uptake.
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case_images: To further investigate, an 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was performed, revealing increased glucose uptake in the nasopharyngeal mass ( Figure 2 ). To confirm a neuroendocrine tumor, an additional 68Ga-DOTATATE PET/CT was performed, which showed a significance tracer uptake in the same lesion ( Figure 2 ), corresponding to the result of the OST.
case_images: Pathological and immunohistochemical staining results of tumors. Under the microscope, the tumor is composed of sheets of uniform small cells with slightly eosinophilic cytoplasm and round to oval nuclei (hematoxylin and eosin, x400). Some tumor cells arrange in a pseudorosette pattern (A). Immunohistochemistry stain (x400) demonstrates diffuse and strong reactivities against both TSH (B) and SSTR2 (C).
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case_images: TSH, GH, PRL, LH, SSTR2, pituitary-specific POU-class homeodomain transcription factor (PIT-1), and estrogen receptor alpha (ERalpha), and negative for FSH, ACTH, transcription factor19 (T-PIT), and steroidogenic factor-1 (SF-1) ( Figure 3 ). The Ki-67 index was 0.5%.