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2b - Answer: 43-year-old female presents history of pituitary microprolactinoma

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 43-year-old female presents history of pituitary microprolactinoma since age 19, and elevated prolactin.

(QUIZ ANSWER) THE PITUITARY MASS INVOLVES: 

All of the above.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS: 

A 1.9 x 1.6 cm partially cystic mildly with mass involving the right sella turcica, sphenoid and right cavernous sinus. Fluid-fluid level may be present within the cystic portion of the lesion. Sphenoid septum is deviated from right to left by the mass. No suprasellar extension. No involvement of the left cavernous sinus. The pituitary stalk is midline. No involvement of the Meckel's cave or foramen ovale. Findings most consistent with a cystic pituitary adenoma, most likely prolactinoma in the described clinical setting.  

Cerebral hemispheres and deep nuclei are without hemorrhage, mass, edema, gliosis, enhancement, or atrophy.  

No extra-axial collection or hemorrhage.  

Ventricular system is normal in size and configuration without hydrocephalus.  

Brainstem and cerebellum are without hemorrhage, mass, edema, gliosis, enhancement, or atrophy.  

Carotid basilar artery flow voids are intact.  

Venous sinuses are patent.  

7th and 8th nerve complexes are intact. Cochlear and vestibule are intact. Otomastoid air space is clear. No internal auditory canal or cerebellopontine angle masses or enhancement.  

The craniocervical junction is unremarkable without Chiari malformation.  

CONCLUSION:

1. Partially cystic pituitary mass extending into the sphenoid and right cavernous sinus without involvement of the foramen ovale or Meckel's cave. Finding is most likely to represent a prolactin secreting macroadenoma in the described clinical setting.  

2. No intracranial hemorrhage or hydrocephalus.

LESSON 2, TOPIC 6

Case Challenge: Sella MRI Cases

Case Challenge

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Content reviewed: July 15, 2021

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