case_images: PMC5287946_01
case_images: MRI for the abnormalities in the sellar region at different time points. A-C, Before the first surgery. A, Coronal-enhanced T1WI. B, Axial-enhanced T1WI. C, Sagittal-enhanced T1WI. D-E, Before gamma-knife treatment. D, Coronal-enhanced T1WI. E, Axial T1WI. F-H, Before the secondary surgery. F, Coronal-enhanced T1WI. G, Axial T1WI. H, Sagittal-enhanced T1WI. I-K, After the secondary surgery. I, Coronal-enhanced T1WI. J, Axial-enhanced T1WI. K, Sagittal-enhanced T1WI. L-P, Before the third surgery. L, Coronal T1WI. M, Coronal-enhanced T1WI. N, Coronal T2WI. O, Sagittal T1WI. P, Sagittal-enhanced T1WI. MRI = magnetic resonance imaging.
case_images: medi-96-e5657-g001.jpg
case_images: PMC5287946_01_medi-96-e5657-g001.jpg
case_images: F1
case_images: The magnetic resonance imaging (MRI) demonstrated an abnormal mixed signal mass with suprasellar, parasellar, and suprasellar invasiveness in the sellar area (Fig. 1A-C). The sellar MRI revealed that the tumor recurred (Fig. 1D and E) and the patient underwent a gamma-knife treatment. Necrosis, cyst degeneration, and hemorrhage within the tumor could be detected (Fig. 1F-H). The sellar MRI after 1 week of the secondary surgery was shown as Fig. 1I to K. The enhancement was inhomogeneous and the surrounding structures and tissues were further invaded (Fig. 1L-P).
case_images: Histopathological and immunohistochemical examination images for the surgical specimen. A-K, Specimen after the first surgery. A, H & E, x10. B, H & E, x20. C, AE-1/AE-3, x10. D, AS-1, x10. E, CD34, x10. F, CD68, x10. G, Desmin, x10. H, S-100 protein, x10. I, SMA, x10. J, SMA, x20. K, Vimentin, x10. L, Specimen after the third surgery, Ki-67 proliferation index 45%, x10. H & E = hematoxylin and eosin, SMA = smooth muscle actin.
case_images: medi-96-e5657-g002.jpg
case_images: PMC5287946_01_medi-96-e5657-g002.jpg
case_images: F2
case_images: Ki-67 proliferation index was 6% (Fig. 2A-K). ASCO. And the Ki-67 proliferation index increased to 45% (WHO III-IV grade, Fig. 2L), highly suggesting its malignancy.