case_images: PMC11152548_01
case_images: (a) Magnetic resonance imaging reveals an intrasellar lesion extending to the suprasellar region. (b) The lesion exhibits an avid contrast enhancement. (c) The mass grows rapidly in a short period and reaches 28 mm in size. (d) It compresses the optic chiasma and left optic nerve and invades the right cavernous sinus. (e) Marked T2 high intensity is characteristic. (f) Mild diffusion restriction is observed. (g) The dorsum sellae shows osteolysis and a bony protuberance is observed at the sellar floor. (h) Fluorodeoxyglucose positron-emission tomography reveals uptake.
case_images: SNI-15-159-g001.jpg
case_images: PMC11152548_01_SNI-15-159-g001.jpg
case_images: F1
case_images: Notably, 2 months before admission, she was incidentally found to have a sellar mass [Figure 1a]. Repeat magnetic resonance imaging (MRI) revealed rapid mass growth [Figures 1b and c]. Imaging studies demonstrated a T1-isointense, T2-hyperintense, heterogeneously enhanced, and irregularly shaped mass with restricted diffusion in the sellar and suprasellar regions [Figures 1c-f]. Marked bony erosion of the posterior clinoid process and dorsum sellae was noted [Figure 1g]. On 18fluorodeoxyglucose positron-emission tomography, the mass exhibited a maximum standardized uptake value of 6.2 [Figure 1h].
case_images: The tumor is soft and grayish and has a gelatinous texture. (a) The normal pituitary gland is displaced at the anterosuperior direction. (b) The tumor is invading the right cavernous sinus and is encasing the right internal carotid artery. (c) The tumor is resected in a piecemeal fashion, and the right internal carotid artery, clival bone, and dorsum sellae are exposed. The dura covering the dorsum sellae is lacerated by the tumor invasion, and the clival bone is exposed without the associated dura. Due to the osteolytic change in the dorsum sellae, the posterior fossa dura is directly exposed. ICA: Internal carotid artery.
case_images: SNI-15-159-g002.jpg
case_images: PMC11152548_01_SNI-15-159-g002.jpg
case_images: F2
case_images: It was soft, grayish, and gelatinous, compressing the normal pituitary gland to the left [Figure 2a] and invading the right cavernous sinus [Figure 2b]. Notably, the bony dorsum sellae was absent, and the sellar side of the dural membrane was almost completely torn by the mass [Figure 2c]. A bony prominence was observed on the left side of the sellar floor [Figure 2c], which also lost its covering dura.
case_images: (a) A gross total resection is achieved. (b) The optic nerve and chiasma are relieved from compression. Histopathological evaluation is compatible with the diagnosis of chordoma. (c) The tumor cells are arranged in nests and cords embedded in a mucoid stroma. (d) These cells exhibit brachyury positivity by immunohistochemistry.
case_images: SNI-15-159-g003.jpg
case_images: PMC11152548_01_SNI-15-159-g003.jpg
case_images: F3
case_images: Postoperative imaging revealed no residual masses [Figures 3a and b]. Histological examination revealed the presence of physaliphorous cells with a background of myxoid stroma [Figure 3c] and positive immunostaining for brachyury [Figure 3d], leading to a diagnosis of conventional chordoma.