case_images: PMC10666160_01
case_images: (A-C) The first MRI examination showed that the lesion invaded the cavernous sinus, with obvious enhancement after enhancement and compression of the optic chiasm. (A) Coronal T1 enhancement; (B) Sagittal T2 imaging; and (C) Axial T1 imaging.
case_images: fneur-14-1253821-g001.jpg
case_images: PMC10666160_01_fneur-14-1253821-g001.jpg
case_images: fig1
case_images: T1 signal shadows within the lesion, which displayed heterogeneous enhancement. The mass encased the right internal carotid artery and compressed the right optic chiasm, resulting in an unclear pituitary stalk (Figure 1).
case_images: (A,B) MRI plain scan showed suprasellar irregular soft tissue signal mass; (C-E) Enhanced MRI scan showed that the lesion was significantly enhanced, the adjacent meninges were enhanced, and the boundary was clear. The mass wrapped the cavernous sinus and the cavernous sinus segment of the internal carotid artery on both sides, broke through the sellar septum upward, and pushed the optic chiasm; (F) CTA showed abundant blood perfusion in the lesion; (G) During the operation, as we can see, the boundary of the lesion was clear, the bilateral internal carotid artery was wrapped, and the blood supply was abnormally rich.
case_images: fneur-14-1253821-g002.jpg
case_images: PMC10666160_01_fneur-14-1253821-g002.jpg
case_images: fig2
case_images: The mass encased the cavernous sinuses and internal carotid arteries bilaterally, extending superiorly through the sellar septum and compressing the optic chiasm (Figure 2).
case_images: Immunohistochemical staining showed the Syn (-), CK (-), GFAP (-), NeuN (-), and Ki-67 (+ 20%).
case_images: fneur-14-1253821-g003.jpg
case_images: PMC10666160_01_fneur-14-1253821-g003.jpg
case_images: fig3
case_images: Next, we performed immunohistochemical staining for GFAP to confirm the presence of glioma, and the results were again negative (Figure 3).
case_images: (A) The distinct fibrosclerotic background; (B) Sclerosis and hyalinization of the wall of small vessels; (C) A large number of lymphocytes; (D) Patches of plasma cells; (E,F) More than 50 IgG4positive cells per high-power field. (G) Ganglion cells under H&E staining; (H) S-100 positivity; (I) CD 3(+); (J) CD 4(+); (K) CD 20(+); and (L) CD 21(+).
case_images: fneur-14-1253821-g004.jpg
case_images: PMC10666160_01_fneur-14-1253821-g004.jpg
case_images: fig4
case_images: Furthermore, immunohistochemistry analysis revealed positive expression of CD3, CD4, CD20, CD21 K(+), and lambda(+) (Figure 4).