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What does my MRI report indicate about the pituitary tumor?

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Posted on Sat, 12 Jul 2014
Question: Hi,

I have contacted Dr XXXXXXX XXXXXXX earlier regarding a Pituitary tumor I have been diagnosed with.

As per the suggestions from the radiologist, I had a second MRI scan and it came out as attached in the report. (also pasting the report at the bottom)

I am really worried about the size and the tumor pressing against something else (I don't know what is 'suprasellar cistern').

Please see the report attached and let me what you think.

Is a surgery necessary? How urgent is it?
What is the usual success rate of surgeries like that.

Thanks,
XXXXXXX

Report:
=========
HISTORY: 30-year-old man with benign neoplasm of pituitary

COMPARISON: None available.

TECHNIQUE:
The following sequences were obtained through the brain on a 3T MR
scanner:
1. Precontrast: Sagittal T1 FLAIR; coronal T2 FSE FS; axial T2 FLAIR,
DWI with ADC map. Coronal T1 FLAIR 2.5 mm were also acquired through
the pituitary.
2. Postcontrast Pituitary: Dynamic coronal T1 2.5 mm during contrast
injection. Coronal T1 FLAIR 2.5 mm; sagittal T1 FLAIR FS 2 mm.
3. Postcontrast Brain: Axial T1 FSPGR with coronal and sagittal
reformats.

IV Contrast: 8.5 cc Gadavist.

FINDINGS:
Parenchyma: No evidence of acute infarct on diffusion weighted
sequence. The parenchyma is normal in appearance except for few,
punctate foci of nonspecific FLAIR hyperintensity in the deep
cerebral white matter, a common finding in this age group. No
abnormal enhancement.

Ventricles and Extra-axial Spaces: Ventricles are symmetric and
normal in size. Extra-axial spaces are unremarkable. No abnormal
enhancement.

Pituitary/Sella: There is a hypoenhancing, T2 hypointense mass lesion
within the pituitary at the expected location of the pars intermedia.
This lesion measures 17 mm transverse, 6 mm AP, and 7 mm
craniocaudal. The stalk and normal pituitary gland are displaced
anteriorly. There is a tiny nodular protrusion into the suprasellar
cistern from the left lateral sellar wall that measures approximately
1-2 mm craniocaudal. Otherwise, the suprasellar cistern is clear.
Adjacent cavernous sinuses are normal in appearance.

Orbits: Orbits are normal.

Sinuses: There is a small mucous retention cyst in the right
maxillary sinus. Mastoid air cells are clear.

Major Vascular Flow Voids: Intact.

Dural venous sinuses: Patent on post-contrast images.

IMPRESSION:

1. Hypoenhancing pituitary mass lesion, most consistent with adenoma.

RADIA

Dictated by: XXXXXXX XXXXX
Dictated: 6/17/2014 4:54 PM
Job: 0000
doctor
Answered by Dr. Sudhir Kumar (5 hours later)
Brief Answer:
Tumor seems to have increased in size.

Detailed Answer:
Hi,

Thank you for sending the reports of new MRI brain.

As per the report, there is a pituitary tumor, and it is most likely an adenoma- a benign tumor.

Surgery is necessary for its treatment, as medical treatment would not be able to reduce the tumor.

Surgery is usually done through the nose and it is very safe.

In my opinion, you should undergo surgery early, as there is a risk to vision due to pressure on the visual nerves due to the tumor.

I hope my reply has helped you.

I would be pleased to answer, if you have any follow up queries or if you require any further information.
     
Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar (7 minutes later)
Dear Dr. XXXXXXX

Thanks for the reply.

I was wondering if the tumor can increased in size so fast or if it could be a reading error (either now or past).

Also, can you also help me understand what it is pressing against? (when the report says "There is a tiny nodular protrusion into the suprasellar
cistern from the left lateral sellar wall that measures approximately
1-2 mm craniocaudal.")

Is it the optical nerve?

Can you also ask what is the success rate of the surgery? Any common complications during/ after the surgery?

Finally, should I be concerned about the "small mucous retention cyst in the right
maxillary sinus"?

Thanks, XXXXXXX
doctor
Answered by Dr. Sudhir Kumar (8 minutes later)
Brief Answer:
It has increased in size.

Detailed Answer:
Thank you for getting back.

The tumor has increased in size, as reading errors are uncommon.

It is pressing most likely against the optic chiasma in the suprasellar cistern.

The success rate of this surgery is close to 95-99%.

In 1-5% of patients, complications can include bleeding, infection, electrolyte imbalance, hormonal disturbances, etc.

Maxillary sinus finding is not of any concern.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar (3 minutes later)
Dear Dr XXXXXXX

Thanks for your prompt responses.

I will setup an appointment with a local neurosurgeon as soon as possible.

Do you have any suggestions for me when choosing one neurosurgeon over another?

Thanks, XXXXXXX
doctor
Answered by Dr. Sudhir Kumar (15 minutes later)
Brief Answer:
An experienced neurosurgeon should be preferred.

Detailed Answer:
Thank you for getting back.

Please choose a neurosurgeon who is experienced in doing pituitary surgeries (not all neurosurgeons have the experience!).

Also, it is important that the hospital has an endocrinologist, as in post-operative period, he would be needed to control the abnormalities in electrolytes (sodium and potassium) and hormones.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Dr. Sudhir Kumar

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What does my MRI report indicate about the pituitary tumor?

Brief Answer: Tumor seems to have increased in size. Detailed Answer: Hi, Thank you for sending the reports of new MRI brain. As per the report, there is a pituitary tumor, and it is most likely an adenoma- a benign tumor. Surgery is necessary for its treatment, as medical treatment would not be able to reduce the tumor. Surgery is usually done through the nose and it is very safe. In my opinion, you should undergo surgery early, as there is a risk to vision due to pressure on the visual nerves due to the tumor. I hope my reply has helped you. I would be pleased to answer, if you have any follow up queries or if you require any further information. Best wishes, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, XXXXXXX For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar My blog: http://bestneurodoctor.blogspot.com/