CASE PRESENTATION
A 47-year-old male presented to the ENT Department (Ear, Nose, and Throat) with a parietal and occipital headache, retro-orbital pain, transient blurry vision, fatigue, and difficulty completing routine tasks. The family and medical history were unremarkable. Laboratory findings showed elevated serum prolactin of 269ng/ml. MRI with contrast of sphenoid sinus and pituitary gland revealed a 2 cm mass within the clivus invading the sphenoid sinus. The mass showed moderate enhancement with peripheral calcifications. The pituitary gland and its stalk were normal, Fig.1 (A, B, C). The mass was totally resected via trans-sphenoidal endoscopic surgery. The posterior portion of the nasal septum was resected, and the inlet was expanded while maintaining the integrity of the sphenopalatine artery. The intersphenoid septum was removed to reach the posterior wall of the sphenoid, which was invaded by the tumour. However, the pituitary gland was notably intact. The neoplastic mass looked friable and it was carefully resected without any vascular or neurologic complications. The internal carotid arteries (ICAs), cranial nerves III/IV/V/VI, and the optic chiasm were all maintained Fig.2 (A, B, C, D). The postoperative period was uneventful. The gross examination revealed fragments of tan, white tissue measuring about 1.2×1×0.5 cm with bony chips. Microscopic examination showed a loosely infiltrating tumour composed of irregular cords and small nests of uniform small oval-to-polygonal-shaped cells surrounded by dense hyaline stroma and bone. In isolated areas, dystrophic calcifications are noted. Immunostains were performed for prolactin, Ki-67, CD138, Epithelial Membrane Antigen, CD45, CD34, S-100, protein, synaptophysin, chromogranin, and CD56. The tumour cells were strongly positive for prolactin, while the others were negative. No cytological malignant features were shown, Fig.3 (A, B, C, D, E, F). Postoperatively, the patient recovered rapidly, his symptoms notably improved, and serum prolactin level dropped to 26ng/ml. On an 18-month follow-up, the patient’s condition was satisfactory with no long-term complications.