28383413 Visualization

n March Date 2015 Date , a 62 Age - year Age - old Age woman Sex was admitted Clinical_event to our hospital Nonbiological_location .
She complained of progressive Detailed_description visual Sign_symptom disturbance Sign_symptom , which began about 4 Date years Date ago Date and was treated as cataract Disease_disorder in local Nonbiological_location hospital Nonbiological_location , but no relief Sign_symptom was seen.
On the contrary, the symptoms Sign_symptom aggravated half Date a Date year Date ago Date , together with headache Sign_symptom , left Biological_structure eye Biological_structure pain Sign_symptom , tearing Sign_symptom and increased secretions Sign_symptom , and the computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) scan of the brain Biological_structure in local Nonbiological_location hospital Nonbiological_location showed a sellar Biological_structure region Biological_structure lesion Sign_symptom .
Besides, 2 Date years Date earlier Date , the patient underwent resection Therapeutic_procedure of melanoma Disease_disorder in the left Biological_structure heel Biological_structure ( T2N0M0 Lab_value , ki67 Lab_value 3–5%, Stage Lab_value II Lab_value ), followed by resection Therapeutic_procedure of the recurred Detailed_description melanoma Disease_disorder nearby Biological_structure the Biological_structure primary Biological_structure site Biological_structure 15 Date months Date later Date ( T3N3M0 Lab_value , Stage Lab_value III Lab_value ), without lymphadenectomy Therapeutic_procedure .
She had no Family_history family Family_history history Family_history of Family_history melanoma Family_history .
On physical Diagnostic_procedure examination Diagnostic_procedure , the patient had bilateral Detailed_description temporal Detailed_description hemianopsia Sign_symptom , the right Diagnostic_procedure finger Diagnostic_procedure counting Diagnostic_procedure was 1 Lab_value   m Lab_value , and the left Diagnostic_procedure finger Diagnostic_procedure counting Diagnostic_procedure was no Lab_value more Lab_value than Lab_value 0.5 Lab_value  m.
Enlarged Sign_symptom lymph Biological_structure nodes Biological_structure were palpable in the right Biological_structure groin Biological_structure .
On ophthalmologic Diagnostic_procedure examination Diagnostic_procedure , the patient had right Diagnostic_procedure vision Diagnostic_procedure of 0.4 Lab_value and left Diagnostic_procedure vision Diagnostic_procedure of 0.08 Lab_value , with the same intraocular Diagnostic_procedure pressure Diagnostic_procedure 15 Lab_value   mm Lab_value Hg Lab_value bilaterally Detailed_description .
The optometry Diagnostic_procedure found the right Biological_structure eye Biological_structure of +6.00DS/+0.25DC∗65° Lab_value and the left Biological_structure eye Biological_structure of +6.25DS/+0.50DC∗20° Lab_value .
The patient had maculopathy Disease_disorder of both Biological_structure eyes Biological_structure and optic Disease_disorder atrophy Disease_disorder of the left Biological_structure eye Biological_structure .
Light Diagnostic_procedure reflex Diagnostic_procedure and eye Diagnostic_procedure movement Diagnostic_procedure of both Biological_structure eyes Biological_structure were normal Lab_value .
CT Diagnostic_procedure scans of the brain Biological_structure parenchyma Biological_structure , orbital Biological_structure , and chest Biological_structure were unremarkable Lab_value .
CT Diagnostic_procedure scan and ultrasound Diagnostic_procedure examination of the abdomen Biological_structure showed hepatic Biological_structure portal Biological_structure and retroperitoneal Biological_structure lymphadenectasis Sign_symptom and enlarged Sign_symptom left Biological_structure lobe Biological_structure of Biological_structure the Biological_structure liver Biological_structure with substantial Severity placeholder Detailed_description lesions Sign_symptom .
Ultrasound Diagnostic_procedure examination of bilateral Detailed_description inguinal Biological_structure lymph Biological_structure nodes Biological_structure discovered multiple Detailed_description low Sign_symptom echo Sign_symptom light Sign_symptom groups Sign_symptom , the largest Distance of Distance which Distance was Distance 31 Distance   mm Distance in diameter, with hilus Detailed_description of Detailed_description the Detailed_description echo Detailed_description and asymmetrical Detailed_description thickening Sign_symptom of the skin Biological_structure .
CT Diagnostic_procedure scan of sellar Biological_structure region Biological_structure revealed a crumby Texture mass Sign_symptom , protruding out of the sphenoid Biological_structure sinus Biological_structure , with obscure Detailed_description boundary Detailed_description and bone Detailed_description destruction Detailed_description .
And the average Detailed_description CT Diagnostic_procedure value Diagnostic_procedure of the mass Sign_symptom was 46 Lab_value   HU Lab_value .
Sellar Biological_structure region Biological_structure magnetic Diagnostic_procedure resonance Diagnostic_procedure imaging Diagnostic_procedure ( MRI Diagnostic_procedure ) revealed a round Shape mass Sign_symptom of 30 Distance   mm Distance in diameter in the enlarged Biological_structure sellae Biological_structure (Fig.1A, B).
The mass Coreference showed isointense Sign_symptom in T1 Diagnostic_procedure - weighted Diagnostic_procedure images Diagnostic_procedure ( T1 Diagnostic_procedure - WI Diagnostic_procedure ) and T2 Diagnostic_procedure - weighted Diagnostic_procedure images Diagnostic_procedure ( T2 Diagnostic_procedure - WI Diagnostic_procedure ), with homogeneous Detailed_description enhancement Sign_symptom after Gadolinium Detailed_description - DTPA Detailed_description injection Detailed_description , and dural Detailed_description tail Detailed_description sign Detailed_description was seen.
Small foci inside the tumor Coreference showed hyperintense Sign_symptom signals Sign_symptom in T1 Diagnostic_procedure - WI Diagnostic_procedure and hypointense Sign_symptom signals Sign_symptom in T2 Diagnostic_procedure - WI Diagnostic_procedure , without Detailed_description enhancement Detailed_description .
And it was seen that the mass Coreference penetrated meninges Biological_structure , surrounded the left Biological_structure internal Biological_structure carotid Biological_structure artery Biological_structure , and was blurred with the left Biological_structure optic Biological_structure nerve Biological_structure .
Pituitary Biological_structure stalk Biological_structure became shorter Sign_symptom with a right Detailed_description displacement Detailed_description .
Laboratory Diagnostic_procedure findings Diagnostic_procedure revealed increased Lab_value levels of prolactin Diagnostic_procedure ( 119.08 Lab_value   μg/L Lab_value , normal range 5.99–30.04 μg/L) and cortisol Diagnostic_procedure ( 677.10 Lab_value   nmol/L Lab_value , normal range 118.60–618.00 nmol/L) and decreased Lab_value levels of free Diagnostic_procedure thyroxine Diagnostic_procedure ( FT4 Diagnostic_procedure ) ( 6.04 Lab_value   pmol/L Lab_value , normal range 12.00–22.00 pmol/L) and free Diagnostic_procedure triiodothyronine Diagnostic_procedure ( FT3 Diagnostic_procedure ) ( 2.09 Lab_value   pmol/L Lab_value , normal range 3.50–6.50 pmol/L).
The patient was diagnosed with a giant Detailed_description prolactinoma Disease_disorder .
The patient underwent transnasal Detailed_description transsphenoidal Detailed_description surgery Therapeutic_procedure to remove the tumor and relieve the compression of the optic nerve.
Intraoperatively, it was seen that the tumor Sign_symptom invaded and filled the left Biological_structure interval Biological_structure of Biological_structure the Biological_structure sphenoid Biological_structure sinus Biological_structure , and part of bone Biological_structure in Biological_structure sellar Biological_structure floor Biological_structure and left Biological_structure side Biological_structure parasellar Biological_structure was destroyed Sign_symptom and absorbed Sign_symptom .
A little Detailed_description normal Detailed_description pituitary Detailed_description tissue Detailed_description was Detailed_description seen Detailed_description in Detailed_description the Detailed_description top Detailed_description right Detailed_description of tumor Coreference in the sellar Biological_structure turcica Biological_structure .
The tumor Coreference was reddish Color black Color with extremely Detailed_description rich Detailed_description blood Detailed_description supply Detailed_description and had close Detailed_description adhesion Detailed_description to Detailed_description the Detailed_description surrounding Detailed_description structure Detailed_description .
The texture in the center of the tumor Coreference was soft Texture and much Texture tougher Texture over Texture the Texture rim Texture .
Intraoperative Detailed_description frozen Diagnostic_procedure - section Diagnostic_procedure examination Diagnostic_procedure found melanin Sign_symptom granules Sign_symptom , and it was considered to be malignant Disease_disorder melanoma Disease_disorder or meningioma Disease_disorder .
The tumor Coreference cells Coreference were composed of eosinophilic Detailed_description staining Detailed_description epithelial Detailed_description cells Detailed_description .
Most of cell Diagnostic_procedure nuclei Diagnostic_procedure were round Shape , a few were reniform Lab_value and hippocrepiform Lab_value with evident Lab_value nucleoli Diagnostic_procedure , and nuclear Diagnostic_procedure fission Diagnostic_procedure was seen Lab_value .
The tumor Coreference showed no evidence of necrosis Sign_symptom (Fig.2).
The tumor was immunopositive Lab_value focally Detailed_description for melanoma Diagnostic_procedure - specific Diagnostic_procedure markers Diagnostic_procedure such as S-100, HMB45 Diagnostic_procedure , and Vimentin Diagnostic_procedure , and immunopositive Lab_value for neuroendocrine Diagnostic_procedure tumor Diagnostic_procedure markers Diagnostic_procedure such as CgA Diagnostic_procedure and Syn Diagnostic_procedure (Fig.3).
The Ki67 Diagnostic_procedure index Diagnostic_procedure was 3% Lab_value to Lab_value 5% Lab_value ; it was higher Lab_value in metastatic Detailed_description melanoma Detailed_description than Detailed_description in Detailed_description the Detailed_description adenomatous Detailed_description component Detailed_description .
Taken the melanoma history and suspected lymph node and hepatic metastasis into consideration, the patient was diagnosised with MMPA Disease_disorder .
After surgery, significant relief Lab_value was seen in visual Diagnostic_procedure field Diagnostic_procedure and headache Sign_symptom , and the level of prolactin Diagnostic_procedure , cortisol Diagnostic_procedure , and FT4 Diagnostic_procedure returned to normal Lab_value with hormone Medication replacement Medication therapy Medication .
Because the focal liver lesions and lymphadenectasis did not cause much discomfort Sign_symptom , the patient refused any further surgical Therapeutic_procedure intervention Therapeutic_procedure or other treatment.
She was discharged Clinical_event from the hospital Nonbiological_location immediately and was disease Disease_disorder free until 2 Date months Date after Date the third surgery.
The patient successively found new melanoma Disease_disorder metastatic Sign_symptom sites Sign_symptom in the skin Biological_structure of Biological_structure lower Biological_structure left Biological_structure leg Biological_structure , knees, the upper Biological_structure left Biological_structure leg Biological_structure , the left Biological_structure groin Biological_structure and the right Biological_structure groin Biological_structure , and the right Biological_structure leg Biological_structure .
At the follow Clinical_event - up Clinical_event in late Date January Date 2016 Date , the patient could not walk Activity and live Activity by Activity herself Activity and was depressed Disease_disorder .
At the latest follow Clinical_event - up Clinical_event , in late Date January, Date 2017 Date , the patient was alive Sign_symptom with worse symptoms Sign_symptom , she had sensory Sign_symptom deficits Sign_symptom of both Biological_structure legs Biological_structure , which could Sign_symptom not Sign_symptom move Sign_symptom , hyperalgesia Sign_symptom of hands Biological_structure and mouth Biological_structure , impaired Sign_symptom intelligence Sign_symptom , but she lived well with the disease by careful nursing Clinical_event of her daughter Subject .