a rare case of intratumoral
postoperative radiotherapy for pituitary adenoma. A 57-year-old Asian male,
complaining of long-standing eye strain, underwent a medical checkup of the
brain. Magnetic resonance imaging showed a multicystic giant pituitary adenoma.
The patient underwent an endoscopic endonasal transsphenoidal partial removal
of the adenoma to provide optic pathway decompression and got relief from the
visual symptoms. Just before completion of the postoperative radiotherapy for
residual adenoma, the patient developed right hemiparesis, mild motor aphasia,
and right oculomotor palsy. A cranial CT scan showed intratumoral hemorrhage
into the intratumoral cyst. The patient therefore had to undergo three
additional craniotomies for evacuation of cyst contents over the next 8 months.
The follow-up MRI at 11 months after the initial hemorrhage showed that the new
oozing of blood in the intratumoral cyst was still appearing. Intratumoral
hemorrhage is a rare, albeit life-threatening, complication of pituitary adenoma. We reviewed relevant literature and suggested that the cystic component in pituitary adenoma could be a key pathogenesis of this rare complication. In conclusion, we suggest that it may be necessary to
realize that cases which have cystic giant pituitary adenoma may
cause hemorrhage by chance with the foreseeability.