Thursday, 27 June 2013

Sellar Suprasellar mass DDs

A 49 yo male.
Non contrast CT, MRI Brain with contrast
Non contrast CT
FLAIR
T2
Non contrast T1
Non contrast T1

Post contrast T1 MRI

MRI BRAIN

This MRI study shows:
A well-demarcated sellar supra sellar solid mass with right para sellar component.
Expansion of right half of Sella. No direct Sphenoid sinus extension.
Size of the mass 46mm width, 30mm AP, and height 48mm.
Mass is multi lobulated, Cysts around the lesion can be attributed to areas of cystic degeneration or an associated adjacent meningeal cysts. Signals are homogeneously isointense on T1w and T2w images. Homogeneous enhancement on post contrast T1.
A tissue resembling Pituitary is seen at the floor of left half of hypophyseal fossa on Sagittal T1 and Post contrast T1 sections.
Extension and mass effect _ Prepontine cistern extension causing Basilar compression and encasement. Mid brain and Pons compressed. Right para sellar component causing encasement of right ICA. Optic Chiasma, Optic nerve significantly compressed.
Low signal intensity hemosiderin staining along sub arachnoid space on T2* GRE attributed to superficial siderosis.
Moderate communicating hydrocephalus.

Imaging wise possible DDs: Meningioma more likely than Macro adenoma as pituitary seen separately.

Operated with right sub frontal approach.

Histopathology Report

Gross appearance : The Specimen consist of friable pieces of dull grey tan tissue. The entire tissue submitted for processing. 
Microscopy : Section shows fragmented bits of hyper cellular neoplasm of probable meningothelial cell origin. Tumour consist largely of cohesive sheets of intermediate sized round to oval cells having modestly hyper chromatic nuclei with delicate - irregularly condensed chromatin and scantly eosinophillic to clear cytoplasm having indistinct cytoplasmic membranes. Many neoplastic cells display nucleoli. Overall the tissue reveals 1 to 2 mitosis per 10 HPF. The interstitial stroma shows numerous congested blood vessels. The adjacent stroma shows foci of hyalinised blood vessels. There is no e/o vascular space invasion. Couple of foci show areas of tumor hemorrhage with focal coagulative necrosis. There is no e/o brain invasion. 

Final Diagnosis : Atypical Meningioma Grade II of III (as per  WHO Classification)