Brain Pathology Case of the Month - August 2001

Contributed by Silke Vogelgesang1 , Michael H. Junge2, Jens Pahnke1, Michael R. Gaab2, Rolf W. Warzok1
  Departments of 1Neuropathology and 2Neurosurgery, University of Greifswald, D - 17489 Greifswald, Germany
Published on line in July 2001


A 59-year-old woman complained of 4 weeks of progressive visual disturbances of the left eye, headache and repeated vomiting. Endocrinologic analysis showed slight hyperprolactinemia and partial insufficiency of the adrenocorticotropic, gonadotropic and somatotropic axes of the anterior hypophysis. Ophthalmologic examination revealed atrophy of the left optic nerve and partial atrophy of the right optic nerve with bitemporal hemianopia. MRI revealed a supra- and intrasellar space-occupying mass with relatively sharp borders, measuring 3.1 x 2.5 x 2.3 cm. In T1-weighted MRI, the tumor was isointense with remarkable contrast enhancement (Fig. 1). At surgical removal by pterional approach, the tumor was found to have infiltrated the optic chiasm. Therefore, complete resection was not possible. No radiotherapy or chemotherapy was applied. Within half a year, rapid visual field loss recurred. MRI revealed a recurrence of the tumor of 2 cm in diameter with marked compression of the optic nerve. Due to the infiltrative behavior of the tumor, a second operation again could not achieve a complete resection of the mass.



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