case_images: PMC7154240_01
case_images: Fundus photographs (a: right eye, b: left eye) and Goldmann visual field perimetry findings (c: left eye, d: right eye) obtained before the first operation in 2010. Fundus examination showed predominant optic disc atrophy in the right eye. Goldmann perimetry findings showed bitemporal hemianopia, and in detail, complete temporal loss and inferonasal defect in the right eye and defects in the temporal half of the left eye.
case_images: cop-0011-0092-g01.jpg
case_images: PMC7154240_01_cop-0011-0092-g01.jpg
case_images: F1
case_images: Color fundus examination showed a predominant optic disc atrophy in his right eye (Fig. 1a, b). Goldmann perimetry showed bitemporal hemianopia, and in detail, complete temporal loss and inferonasal defect in the right eye and defects in the temporal half of the left eye (Fig. 1c, d); thus, we suspected the patient to have a pituitary adenoma and subsequently referred him to the Department of Neurosurgery for further examination.
case_images: MRI images of the patient's head obtained before the first operation in 2010 and before the second operation in 2017. Before the first operation in 2010, the MRI sagittal (a) and coronal section (b) showed a giant cystic mass approximately 4 cm in diameter extending from the intrasellar region to the sphenoid sinus and the suprasellar region. Before the second operation in 2017, the MRI sagittal (c) and coronal section (d) showed a giant cystic mass larger than 8 cm in diameter in the suprasellar region (T1-weighted image).
case_images: cop-0011-0092-g02.jpg
case_images: PMC7154240_01_cop-0011-0092-g02.jpg
case_images: F2
case_images: Magnetic resonance imaging (MRI) of the sagittal section (Fig. 2a) and the coronal section (Fig. 2b) showed a giant cystic mass of approximately 4 cm in diameter extending from the intrasellar region to the sphenoid sinus and suprasellar region. A subsequent MRI examination revealed a giant cystic mass larger than 8 cm in diameter in the suprasellar region (Fig. 2c, d), and the patient was diagnosed with advanced recurrent pituitary adenoma.
case_images: Histopathological finding of the tumor tissue collected at the first operation (a: hematoxylin and eosin stain, b: immunostaining for ACTH). Immunostaining of the tumor tissue, which was collected intraoperatively, showed adrenocorticotropic hormone (ACTH)-positive cells.
case_images: cop-0011-0092-g03.jpg
case_images: PMC7154240_01_cop-0011-0092-g03.jpg
case_images: F3
case_images: Immunostaining of the patient's tumor tissue, which was collected intraoperatively, showed adrenocorticotropic hormone (ACTH)-positive cells (Fig. 3a, b), thus resulting in a diagnosis of ACTH-producing pituitary adenoma.