case_images: PMC11302597_01
case_images: (a-d) Gadolinium-enhanced magnetic resonance (MR) images before the 1st operation and 1 year before the presentation. The heterogeneously enhanced tumor is observed in the sella with suprasellar extension before surgery. No tumor recurrence is apparent at 8 years after surgery. MR images at presentation. An extensively enlarged tumor in the sellar and suprasellar portion with optic nerve compression. (e-h) The tumor is shown isointense on T1-weighted images (WI), having iso-low mixed intensity on T2-WI, and heterogeneously enhanced by gadolinium.
case_images: SNI-15-262-g001.jpg
case_images: PMC11302597_01_SNI-15-262-g001.jpg
case_images: F1
case_images: Her magnetic resonance (MR) images showed a mass in the sellar region compressing the chiasma [Figure 1]. A year before the presentation, she did not have any symptoms, and her MR images did not show tumor recurrence [Figure 1]. The mass was heterogeneously enhanced with gadolinium [Figure 1] but no other brain lesions were found.
case_images: (a: Hematoxylin and eosin (H&E) stain, Magnificationsx400) Histological analysis of resected tumor tissue. Tumor cells have round hyperchromatic nuclei and sparse eosinophilic cytoplasm. No apparent necrotic lesion is observed. (b: CD3, c: CD4, d: CD8, e: CD20, f: CD56, g: TdT) Immunohistochemical analysis reveals that tumor cells were positive for CD3, CD4, CD8, and terminal deoxynucleotidyl transferase (TdT) and negative for CD20 and CD56 Magnifications: x400. Scale bars: 20 mum (a-g).
case_images: SNI-15-262-g002.jpg
case_images: PMC11302597_01_SNI-15-262-g002.jpg
case_images: F2
case_images: The immunological analysis showed that tumor cells were positive for CD3, CD4, CD8, and terminal deoxynucleotidyl transferase, which confirmed the diagnosis of T-lymphoblastic lymphoma (T-LBL) [Figure 2].
case_images: (a and b) Postoperative magnetic resonance (MR) images. T2-weighted image (WI) shows the residual tumor attached to the right cavernous sinus and suprasellar portion ([a] Coronal, [b] Sagittal). (c) Gadolinium-enhanced MR fluid-attenuated inversion recovery image taken 14 days after the second surgery shows pial enhancement on the brain stem and cerebellum and indicates intrathecal dissemination. (d and e) Gadolinium-enhanced T1-WI after chemoradiotherapy (11 months after the second surgery) shows an enhanced region in the sellar portion and clivus (arrows) and pial enhancement from the brain stem to the spinal cord (arrowheads).
case_images: SNI-15-262-g003.jpg
case_images: PMC11302597_01_SNI-15-262-g003.jpg
case_images: F3
case_images: MR images showed pial enhancement in the brain stem in a fluid-attenuated inversion recovery image, diagnosed as tumor meningeal dissemination [Figure 3].
case_images: Positron emission tomography. Tracer accumulation is seen in the pancreas (arrow). No other tracer accumulation is apparent elsewhere.
case_images: SNI-15-262-g004.jpg
case_images: PMC11302597_01_SNI-15-262-g004.jpg
case_images: F4
case_images: Full body positron emission tomography (PET) showed tracer accumulation in the pancreas [Figure 4], also confirmed as the same type of lymphoma by biopsy through endoscopic ultrasound-guided fine-needle aspiration.