NeuroSim Case #04: 20 year-old patient with a sellar-suprasellar mass and sudden loss of vision.

History: The patient was a 20 year-old man who complained headache for several days with sudden and complete vision loss in his right eye. Neurologic examination shows complete blindnes in the right eye and a defect of the lateral visual field in the left eye. There was no evidence of acromegaly or gynecomastia on physical examination. No elevation of hormone in serum was demonstrated. The prior medical history was not remarkable.

Imaging: An MRI disclosed a large (3.8 cm) mass that extended from the sella to the supracellar region with compression of the optic nerves; the sella is expanded by the tumor mass. There was no cystic component. A CT scan showed a high-intensity mass, indicating hemorrhage of pituitary. No calcification is noted.

Specimen: An emergent resection yielded multiple fragments of tan hemorrhagic tissue that required 5 cassettes to submit them entirely. The bulk of the specimen was composed of necrotic tissue fragments as illustrated in panel A (2X objective), panel B (10X objective). Significant amount of viable cells as illustrated in panel C (60X objective) were only found in one of the five blocks and comprised less than 5% of the tissue in that block.

How to work up a Sellar-Suprasellar Region

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