Male, 85 years old, history of pituitary lesion, assess for progression in size. Again seen is an enhancing mass involving the sella measuring approximately 12 x 13 x 15 mm in the AP, transverse, and craniocaudal dimensions, which is not appreciably changed allowing for slight differences in scan planes. There is mild suprasellar extension without any mass effect on the optic nerves or chiasm. The mass extends to abut the right cavernous sinus without evidence of cavernous sinus invasion. The pituitary stalk deviates toward the left as before. Small amount of enhancing tissue in the left aspect of the sella is presumed to reflect normal pituitary tissue. Limited evaluation of the brain demonstrate scattered foci of T2/FLAIR hyperintensity in the white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes. There is evidence of volume loss, commensurate with patient's advanced age. Noted is extra-axial enhancing lesion along the left frontal convexity measuring approximately 4-5 mm in thickness and 2 cm in the craniocaudal extent. This lesion is stable to minimally larger when compared to prior study from 1/31/2014, but inadequately compared in the absence of dedicated brain sequences on the current or prior study. There is minimal local mass effect on the left middle frontal gyrus. No midline shift or evidence of herniation. Small left maxillary mucus retention cyst incidentally noted.
1. Compared to 1/31/2014, there is no significant change in enhancing sellar mass compatible with a macroadenoma. As seen before, there is minimal suprasellar extension without mass effect on the optic nerves or chiasm.2. Extra-axial enhancing lesion along the left frontal convexity likely represents a small meningioma and appears stable to minimally larger when compared to prior study from 1/31/2014. There is minimal local mass effect on the adjacent left middle frontal gyrus. If clinically indicated, dedicated MRI brain may be obtained for further assessment.