Presentation
Adult patient with severe headache, secondary amenorrhea of one year's duration, anopia of the right eye and temporal hemianopia of the left eye
Patient Data
MRI demonstrating a large pituitary macroadenoma grade IV-E Hardy Vezina and grade III Knosp, extending upward out of the enlarged fossa and compressing the optic chiasm and extending anteriorly into the sphenoid sinus.
Histology
Macroscopic description:
Two fragments of tissue, the largest measuring 0.4 x 0.2 x 0.1 cm and the smaller than 0.3 x 0.2 x 0.1 cm, are reddish-brown, irregular, and soft. Imprinting and frozen cutting are made.
Immunohistochemistry: -KI-67: with cell proliferation index of 1-2%
GATA-3: negative
Diagnosis: compatible with pituitary adenoma.
Case Discussion
This case demonstrates the appearance of a sizable pituitary macroadenoma.
Visual alterations are very common in pituitary masses and depend on the size, location and hormonal activity of the tumor, as well as the position of the chiasm in relation to the sella turcica 1. Patients with pituitary macroadenomas typically present with bitemporal hemianopsia, as a consequence of an elevated and compressed optic chiasm 2.
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