Primary undifferentiated spindle-cell sarcoma of sella turcica: successful treatment with adjuvant temozolomide

Abstract

Sellar tumours in adults are most commonly pituitary adenomas. Primary spindle cell sarcoma of the sella turcica without a prior history of cranial radiation is extremely rare. We report a case of a large sellar mass with suprasellar and cavernous sinus extension in a geriatric male patient who presented with complete left oculomotor nerve palsy and panhypopituitarism. The patient underwent partial resection of the sellar mass through transcranial route. The pathology of the mass revealed a poorly differentiated spindle cell neoplasm most consistent with a sarcoma. Postoperatively, the size of the residual sellar mass decreased significantly following six cycles of external beam radiation in conjunction with temozolomide.

Figure 1

(A) Figure reveals complete ptosis of the left eye. (B) The left eye has mydriasis and fixed ‘downward and outward gaze’, consistent with dense left oculomotor palsy. (C). Contrast-enhanced T1 coronal section of MRI of the brain showing a large bilobed left sided, sellar mass with cavernous sinus extension. (D and E) Haematoxylin and eosin stained sellar tissue sections on high and low magnifications respectively. Spindle cells with fusiform nuclei with finely granular chromatin and insignificant nucleoli reveal characteristics of spindle cell sarcoma.

Figure 2

Figure represents a patient follow-up image 6 months after postoperative surgical resection and radiotherapy. The patient is currently on temozolamide. There is significant improvement in his visual symptoms. Left eye ptosis has partially resolved.