Diagnosis: Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch) Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch)Clinical question: assess size of pituitarySigns and Symptoms: assess size of prolactinoma There is no indication on the scans that contrast entered the patient's vascular system.There is opacification of the sphenoid sinus with mixed high signal T1 material and intermediate signal material. Anteriorly there is some high signal material on T1-weighted imaging which does not suppress on the fat suppressed images that measures approximately 12 x 16 mm axial dimensions and is suspected represent inspissated secretions. Just behind that within the sphenoid sinus there is soft tissue signal intensity which is heterogeneous on T1 and intermediate signal on T1 this measures approximately 13 x 10 mm axial dimensions and is eccentric towards the right side and appears to be contiguous with the pituitary gland. Measures 19 x 12 mm on sagittal imaging. There is a lesion present in the right half of the pituitary fossa and gland measures approximately 9 x 10 mm coronal dimensions. It is contiguous with a lesion in the sphenoid sinus and involves the clivus. Overall the lesion measures 23x17mm coronal dimensions and 19mmx19mm sagittal dimensions. The lesion bulges into the right cavernous sinus and abuts the right ICA. It enhances heterogenously. It has heterogeneous but predominantly low signal on T2-weighted imaging. It does not appear to have changed substantially since the March exam. The infundibulum of the pituitary gland is slightly tilted towards the left.The infundibulum of the pituitary gland is tilted to the left. No suprasellar mass is identified. There are opacities present within the maxillary sinuses bilaterally most likely representing mucous retention cysts.
1.There is a mass present which involves the pituitary fossa and the clivus and bulges into the right cavernous sinus. Most likely this is a pituitary adenoma with some inspissated secretions in the sphenoid sinus. However, given its involvement of the clivus and the unusual signal characteristics and involvement of the sphenoid sinus other considerations such as intrasellar chordoma mimicking a pituitary adenoma are also possible. Please correlate with the patient's endocrinological exam.2.Please note that contrast did not reach the tissues. The patient will be asked to return to complete the exam.