Neuroradiology Board Review – Brain Tumors – Case 5
Neuroradiology brain tumor board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.
More description and the answer (spoiler!) are seen below the video.
This case shows images from an MRI through the sella, including both coronal and sagittal images. There is expansion of the sella with a T1 isointense, T2 hyperintense mass replacing the sella and extending beyond the margins of the sella, including the cavernous sinuses bilaterally. The sella itself is also expanded. On postcontrast imaging, you see a pretty avidly enhancing sellar and suprasellar mass with no real risidual pituitary seen.
The diagnosis is: pituitary adenoma
Pituitary adenomas are extremely common brain masses and are very common incidental masses. They arise in the sella but can extend into the cavernous sinuses and suprasellar region. About half of these masses are non-secreting, while the most common secreting tumor is a prolactinoma. On imaging, they often enhance but typically enhance a little bit less than the surrounding normal pituitary. They can hemorrhage and have cystic degeneration. Because adenomas are slow-growing lesion, the sella is often expanded and remodeled but may not be completely destroyed.
When patients have pituitary hemorrhage, this is called apoplexy. This most often occurs in patients with an underlying adenoma. This is associated with a variety of conditions, including pregnancy/postpartum state, treatment of a prolactinoma with bromocriptine, and cerebral angiography (although admittedly I’ve never seen this).