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.