J Korean Soc Radiol.  2016 Dec;75(6):450-454. 10.3348/jksr.2016.75.6.450.

A Primary Sellar Neuroblastoma Mimicking a Pituitary Adenoma: A Case Report

• Kim DG
• Heo YJ
• Kim EK
• Baek JW
• Jeong HW
• Jung HS

• KMID: 2360432
• DOI: http://doi.org/10.3348/jksr.2016.75.6.450

Abstract

Intracranial neuroblastomas are uncommon malignant tumors that usually arise in the supratentorial parenchymal or paraventricular location. A primary neuroblastoma arising in the sella turcica is extremely rare. We report a case of a 76-year-old man who presented with progressive bitemporal hemianopsia. His pituitary hormone levels were within the normal range, except for slightly increased prolactin. Pituitary magnetic resonance imaging revealed a solitary sellar mass with supra- and parasellar extension that mimicked a non-functioning pituitary adenoma or meningioma. The tumor was excised by transsphenoidal resection. Histopathologic analysis revealed small cells surrounded by a dense fibrillary stroma as well as strong expression of neural markers. Hence, the patient was diagnosed with sellar neuroblastoma. Prolactin levels normalized in the immediate postoperative period, although visual disturbances persisted. Herein, we describe the clinical manifestations, MRI characteristics, and histopathologic findings of this case.

MeSH Terms

Aged
Hemianopsia
Humans
Magnetic Resonance Imaging
Meningioma
Neuroblastoma*
Pituitary Neoplasms*
Postoperative Period
Prolactin
Reference Values
Sella Turcica
Prolactin

Figure

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  Fig. 1 A 76-year-old man with a primary sellar neuroblastoma. Axial fluid attenuation inversion recovery (FLAIR) magnetic resonance (MR) image (A) and T1-weighted MR image (B) show a homogeneous mass, with iso-signal intensity on T1-weighted image, and high signal intensity on FLAIR image with left posterolateral displacement of the neurohypophysis (arrows). Contrast-enhanced T1-weighted coronal (C) and sagittal (D) MR images show a well-enhancing large sellar mass with supra- and parasellar extension. Furthermore, there is no evidence of abnormalities in the paranasal sinuses or the floor of the sella turcica.

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  Fig. 2 Histopathologic examination of the excised sellar mass. Hematoxylin and eosin staining (A: magnification × 100) reveals tumor lobules separated by dense fibromuscular tissue (arrows). The neoplastic cells have small, round, inconspicuous nuclei, scant cytoplasm, and dispersed coarse to fine nuclear chromatin. Nuclear pleomorphism is substantial but mitotic activity and necrosis is absent. Neural markers (B: Synaptophysin, C: neuron-specific enolase, and D: neural cell-adhesion molecule/CD56, magnification × 200) show strong positive staining.

Reference

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