case_images: PMC10559392_01
case_images: (a) Magnetic resonance imaging brain sagittal T2 sequence showing hyperintense signal along the wall of the sphenoid and partially along the ethmoid sinus, suggestive of sinusitis, and a hypodense lesion in the sellar region (orange arrow) with dense central hypodensity (dot sign) (green arrow), compressing the normal pituitary gland inferoposteriorly (blue arrow). (b) Interval magnetic resonance imaging brain sagittal T1 sequence showing hyperintense sellar lesion (orange arrow), coronal T2 sequence showing resolved sinusitis and hypointense sellar lesion with central nodule (green arrow), and a sagittal post-contrast sequence showing nonenhancing lesion (black arrow) and mildly enhancing nodule (red arrow) with normal enhancing pituitary gland (yellow arrow). (c) Contrast-enhanced computed tomography brain showing a hyperdense lesion in sella (orange arrow) in sagittal and axial sections.
case_images: SNI-14-327-g001.jpg
case_images: PMC10559392_01_SNI-14-327-g001.jpg
case_images: F1
case_images: After the failure of initial management with analgesics, and ruling out other nonorganic causes of headache, she was evaluated with magnetic resonance imaging (MRI) brain and was found to have sinusitis [Figure 1a], showing T2 hyperintense signal along the wall of the sphenoid sinus and partially along ethmoid sinus, with an incidental finding of a hypointense lesion in anterior sella pushing the whole of normal pituitary gland inferoposteriorly. After a month, she had symptomatic relief in headache, and a follow-up contrast MRI was done which was suggestive of resolved sinusitis, but no interval change in the lesion [Figure 1b], which was hyperintense on T1, hypointense on T2, with no contrast enhancement and a densely hypointense nodule in the center, which was mildly enhancing. Further, a contrast computed tomography (CT) brain was done, showing nonenhancing hyperdense lesions without calcifications [Figure 1c].
case_images: (a) Intraoperative microscopic image showing viscous white mucoid content (blue arrow) oozing out. (b) Intraoperative microscopic image showing thin translucent capsule (marked in blue oval) and a firm yellow nodule (arrow). (c) Postoperative contrast-enhanced magnetic resonance imaging brain sagittal section showed no residual lesion and a normal enhancing pituitary gland (orange arrow), which has expanded after the excision of the lesion.
case_images: SNI-14-327-g002.jpg
case_images: PMC10559392_01_SNI-14-327-g002.jpg
case_images: F2
case_images: Intraoperatively, as soon as the dura was opened, viscous white mucoid content oozed out [Figure 2a], a thin translucent capsule was seen along with a firm yellow nodule [Figure 2b], which was easily dissected off and normal hypophysis visualized. Her postoperative course was uneventful, with a contrast-enhanced MRI after a month showing complete excision of the lesion [Figure 2c].