1/374. Post-traumatic pituitary apoplexy--two case reports.A 60-year-old female and a 66-year-old male presented with post-traumatic pituitary apoplexy associated with clinically asymptomatic pituitary macroadenoma manifesting as severe visual disturbance that had not developed immediately after the head injury. skull radiography showed a unilateral linear occipital fracture. magnetic resonance imaging revealed pituitary tumor with dumbbell-shaped suprasellar extension and fresh intratumoral hemorrhage. Transsphenoidal surgery was performed in the first patient, and the visual disturbance subsided. decompressive craniectomy was performed in the second patient to treat brain contusion and part of the tumor was removed to decompress the optic nerves. The mechanism of post-traumatic pituitary apoplexy may occur as follows. The intrasellar part of the tumor is fixed by the bony structure forming the sella, and the suprasellar part is free to move, so a rotational force acting on the occipital region on one side will create a shearing strain between the intra- and suprasellar part of the tumor, resulting in pituitary apoplexy. Recovery of visual function, no matter how severely impaired, can be expected if an emergency operation is performed to decompress the optic nerves. Transsphenoidal surgery is the most advantageous procedure, as even partial removal of the tumor may be adequate to decompress the optic nerves in the acute stage. Staged transsphenoidal surgery is indicated to achieve total removal later.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
2/374. Hepatic adenomatosis: rapid sequence MR imaging following gadolinium enhancement: a case report.Hepatic adenomas are primary liver tumors usually associated with underlying metabolic disease or with anabolic steroid or oral contraceptive use. Hepatic adenomatosis (HA) is defined as the presence of more than four adenomas. Only 13 cases of HA have been reported in patients without glycogen storage disease or steroid use. We report a case of HA imaged by postcontrast T1-weighted images obtained during a breath-holding series. The lesions were most conspicuous 3-4 min after contrast administration; 4 of the 5 tumors were not identified on T2-weighted images. Unlike previous reports of HA in which the lesions remained hyperintense during sequential postcontrast imaging, the smaller lesions in this case demonstrated contrast washout, thereby distinguishing them from hemangiomata.- - - - - - - - - - ranking = 0.89194896014886keywords = contrast (Clic here for more details about this article) |
3/374. Aggressive giant pituitary adenoma presenting as a nasopharyngeal mass: magnetic resonance imaging and pathologic findings.We report a giant pituitary adenoma with aggressive histologic features that prominently invaded the nasopharynx. magnetic resonance imaging (MRI) demonstrated a large heterogeneous nodular mass that was hypointense to isointense on T1-weighted images and mixed hypointense, isointense, and hyperintense on T2-weighted images. The mass measured 7.5 x 5 x 7 cm, extending from the nasopharynx posteriorly through the clivus, and superiorly through the paranasal sinuses, and sellar-suprasellar region. After contrast administration, heterogeneous nodular enhancement was noted. A nasopharyngeal neoplasm extending into the sella was suspected because voice change and nasal speech long preceded the patient's visual symptoms. A biopsy disclosed an aggressive, infiltrating, hemorrhagic tumor, which was diagnosed as a non-secreting pituitary macroadenoma. This report indicates that pituitary adenomas may grow invasively to tremendously large sizes resulting in their initial presentation as nasopharyngeal masses.- - - - - - - - - - ranking = 0.55632057337055keywords = visual, contrast (Clic here for more details about this article) |
4/374. Intrasellar paraganglioma presenting as nonfunctioning pituitary adenoma.Paragangliomas arising in the sellar region are rare. We report a case of intrasellar paraganglioma of a 54-year-old man who presented with gradually decreasing visual acuity. physical examination revealed bitemporal hemianopsia with no apparent signs of endocrinologic dysfunction. magnetic resonance imaging revealed a large sellar mass believed to be a nonfunctioning pituitary adenoma. The tumor was removed transsphenoidally and submitted for histologic examination. The morphologic features, based on histologic, immunocytochemical, and electron microscopic analyses, were consistent with the diagnosis of paraganglioma. The diagnostic morphologic features and the immunocytochemical profile of the tumor are reported.- - - - - - - - - - ranking = 0.33333333333333keywords = visual (Clic here for more details about this article) |
5/374. Clinical and morphological features of undifferentiated monomorphous GH/TSH-secreting pituitary adenoma.A 41-year-old male presented with progressive visual defects, acromegaly and hyperthyroidism. After clinical evaluation a giant GH/TSH-secreting pituitary adenoma was diagnosed. Administration of the somatostatin analog octreotide at doses of 150 microg s.c. per day inhibited the secretion of both GH and TSH. A three-week treatment with octreotide prior to surgery led to slight visual improvement and CT scan showed some new necrotic areas within the tumor mass. Transcranial surgery was performed. By immunohistochemical analyses of the adenoma tissue GH, prolactin and beta-chorionic gonadotropin were detected; TSH was negative. Electron microscopy revealed an undifferentiated, monomorphous adenoma with morphological features of an acidophil stem cell adenoma such as the presence of misplaced exocytoses, fibrous bodies and mitochondrial gigantism. However, the tumor cells contained small secretory granules (up to 250 nm) accumulated along the cell membrane characteristic of thyrotrope cells. Furthermore, some adenoma cells were fusiform with long cytoplasmic processes resembling thyrotropes. Two months after the operation CT scan revealed a large residual tumor. serum GH and TSH levels had increased again and the TSH level was even higher than before the treatment. The patient died suddenly, most probably of lethal arrhythmia. Specimens of the adenoma tissue obtained at autopsy confirmed the previous findings with the exception of positive immunostaining for TSH which was found in less than 1% of the adenoma cells. This undifferentiated, monomorphous GH/TSH-secreting pituitary adenoma represents an entity that is unusual both in its ultrastructural features and clinical manifestations suggesting a cytogenesis from an early, undifferentiated stem cell.- - - - - - - - - - ranking = 0.66666666666667keywords = visual (Clic here for more details about this article) |
6/374. Secondary infertility as early symptom in a man with multiple endocrine neoplasia-type 1.multiple endocrine neoplasia-type 1 (MEN1) is an autosomal dominant familial cancer syndrome characterized by parathyroid hyperplasia, pancreatic endocrine tumours and pituitary adenomas. Here, we report a patient with a history of insulinoma who developed secondary infertility as a further symptom of the disease. When he was first examined at the age of 36 years, he complained of weakness, reduced libido and impotence. Laboratory evaluation revealed non-obstructive azoospermia and hyperprolactinaemia. In contrast to sexual activity and serum prolactin, semen quality did not significantly respond to bromocriptine therapy. During follow-up, a growing pituitary adenoma caused acromegaly with elevated serum concentrations of growth hormone, insulin-like growth factor 1 (IGF-1), and prolactin. After microsurgery of the tumour at the age of 44 years, sperm concentration persistently increased up to 5.6 x 10(6)/ml. In accordance with the clinical diagnosis of MEN1, dna sequencing revealed a mutation in exon 2 of the menin gene which results in a truncated, inactive protein product. In conclusion, MEN1 with pituitary lesions may cause severe hypogonadism and infertility. Both hyperprolactinaemia and overproduction of growth hormone and IGF-1 seem to be involved in testicular dysfunction in the present case. The possible role of menin in the testis, however, remains to be elucidated.- - - - - - - - - - ranking = 0.22298724003721keywords = contrast (Clic here for more details about this article) |
7/374. The perils of a sneeze.A 51-year-old woman had a 3-day history of severe left supraorbital pain associated with blurred vision of the left eye. Examination revealed visual acuity of 20/20 OD and 20/100 OS. A left relative afferent pupillary defect was present. neuroimaging revealed a large intra-, supra-, and parasellar mass that had eroded through the sphenoid sinus into the maxillary sinus. Secondary pneumocephalus was present. Pathologic examination of the tissue revealed a pituitary adenoma of the null cell type. To the best of our knowledge, there is only one other case in the literature in which a spontaneous pneumatocele represents the initial manifestation of a pituitary adenoma.- - - - - - - - - - ranking = 0.33333333333333keywords = visual (Clic here for more details about this article) |
8/374. Clinics in diagnostic imaging (34). Invasive pituitary macroadenoma.A 44-year-old woman presenting with headache and decreased visual acuity was found to have bilateral papilloedema. Radiograph showed an enlarged pituitary fossa. MR scans demonstrated a large solid tumor with central necrosis, and both suprasellar and infrasellar extension. The invasive pituitary macroadenoma was surgically debulked, followed by radiotherapy. The clinical and imaging features of pituitary macroadenomas are discussed.- - - - - - - - - - ranking = 0.33333333333333keywords = visual (Clic here for more details about this article) |
9/374. Compression of the prechiasmatic optic nerve produces a junctional scotoma.PURPOSE: To demonstrate the clinical-radiologic correlation between a junctional scotoma and a focal lesion compressing the prechiasmatic segment of the distal optic nerve. methods: Case report involving a man with a pituitary adenoma. Clinical correlation was determined by reviewing visual field evaluations and magnetic resonance images. RESULTS: The tumor compressed the prechiasmatic segment of the distal optic nerve but not the optic chiasm, producing a junctional scotoma documented by Goldmann and automated perimetry. The visual field defect resolved after neurosurgical decompression of the anterior visual pathway. CONCLUSIONS: A junctional scotoma can be caused by focal as well as large and diffuse lesions injuring the anterior visual pathway, specifically at the junction of the optic nerve and chiasm. This finding supports the existence of Wilbrand fibers.- - - - - - - - - - ranking = 1.3333333333333keywords = visual (Clic here for more details about this article) |
10/374. Long-term magnetic resonance imaging follow-up of asymptomatic sellar tumors. -- their natural history and surgical indications.Serial magnetic resonance (MR) images and clinical symptoms were analyzed in 23 patients with sellar lesions, who were followed up without initial therapy for mass reduction to evaluate their natural history and surgical indication for these lesions. The patients were aged 17 to 78 years (mean 47.3 years) and the follow-up period was 1.5 to 11.6 years (mean 5.1 years). Lesions were divided into two types based on the MR imaging findings, regardless of their histological types. Type C was cystic with or without enhancement of the smooth and thin wall. Type S had enhanced solid components. Ten patients had Type C tumors. Three patients presented with sudden onset of headache. The tumor size spontaneously decreased with intensity change, indicating pituitary apoplexy as the trigger of the onset and intensity change. Four patients presented with the visual disturbance which improved with the reduction of tumor size, but three patients deteriorated and required surgery. The operation revealed Rathke's cleft cyst. The remaining three patients were found incidentally and have been asymptomatic without MR imaging changes. Thirteen patients had Type S tumors. Six patients of nine with 14 mm or larger tumors developed symptomatic tumor enlargement over the follow-up period of 1.2 to 8.6 years (mean 4.9 years) and required treatment. The remainder showed no change. Type C tumors frequently shrink or even disappear spontaneously. We can justify conservative follow-up of Type C tumors in patients with no or only transient symptoms. Type S tumors, larger than 14 mm in size, need closer observation or treatment because they often enlarge and become symptomatic.- - - - - - - - - - ranking = 0.33333333333333keywords = visual (Clic here for more details about this article) |
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