case_images: PMC9609953_01
case_images: MRI showing PM and. (a-d) Preoperative coronal and sagittal T1 MRI with and without contrast showing a lesion in the pituitary stalk and gland. There is mild splaying of the optic chiasm with lateral displacement of the left optic nerve. (e and f) A residual tumor involving the stalk and hypothalamus was identified on postoperative coronal and sagittal T1 MRI with contrast. (g and h) A follow-up MRI of the brain and cervical spine with contrast showed a leptomeningeal metastatic disease. (i) A follow-up MRI of the brain with contrast showing hydrocephalus due to leptomeningeal disease. A palliative ventriculoperitoneal shunt was placed.
case_images: SNI-13-462-g001.jpg
case_images: PMC9609953_01_SNI-13-462-g001.jpg
case_images: F1
case_images: A magnetic resonance image (MRI) demonstrated a 1.6 x 1.7 x 2.5 cm lesion on the pituitary stalk [Figures 1a-f]. While her residual tumor involving the stalk and hypothalamus had diminished in size, multiple intracranial areas of abnormal enhancement involving the cerebellum, brainstem, and supratentorial sulci were present [Figure 1g]. Leptomeningeal metastases were also seen in the spinal cord [Figure 1h]. April 2021, she was diagnosed with hydrocephalus [Figure 1i]. A palliative ventriculoperitoneal shunt was placed, but she succumbed to the disease in May 2021.
case_images: Histological appraisal of PM. (a) Hematoxylin and eosin stained section demonstrating neoplastic cells with anaplastic nuclei, prominent nucleoli, and mitotic activity. (b) Cytokeratin 7 immunohistochemically stained section showing strong, diffuse cytoplasmic immunopositivity. (c) Cytokeratin 20 immunohistochemically stained section showing immunonegativity. (d) Gata3 labeled section showing strong nuclear positivity.
case_images: SNI-13-462-g002.jpg
case_images: PMC9609953_01_SNI-13-462-g002.jpg
case_images: F2
case_images: Immunohistochemical analysis of the PM revelaed positivity for ER, PR, and HER2 [Figures 2a-d].