Expert: Claes-Gustaf Nordquist, M.D. - 1/15/2010

Question
QUESTION: My 25 year old daughter received results from a CT today. The doctor insist that she see a neurologist. He was talking to her about her pituitary gland,she was trying to understand what he was saying, but she was upset and couldn't remember all of it. Below is the information that he gave her. Can someone explain what this means?

1.3 cm low attenuation mass like lesion along the inferior posterior margin of the sphenoid sinus and anterior sella.

Fluid within an empty sella rather than a mass lesion.

Does not appear to be a polyp within the sphenoid sinus based on the axial CT images.

ANSWER: In situations like this it is usually best to have someone (friend or relative) going with you to the doctor since there is a risk of being emotionally too upset to be able to understand any message (I'm not only a cancer doctor but also a cancer patient myself so I know exactly what it is like).

Now to her CT result. There seems to be a 1.3 cm (0.5 of an inch) big tumor of unknown nature along the lower back margin of her sinus right behind her nose and the forward part of her "saddle" (= a bone structure at the bottom of her brain closely behind her sinus behind her nose and the location of her pituitary - hypophysis - gland). There is fluid within her "saddle" which is empty without any mass/tumor (or presumably any pituitary). According to her axial CT there seems to be no polyp within her sinus right behind her nose.

I agree that she should see a neurologist or rather a neurosurgeon urgently. A biopsy can be done via her sinus behind her nose (easier than full neurosurgery) and that can even be done by an ear-nose-and-throat surgeon. A biopsy is necessary to know what we are dealing with. I would also strongly suggest an MRI head scan to complement her CT scan. Her tumor is small enough to be eradicated radiologically with the so called GammaKnife or proton beams without any further surgery if that in other ways is regarded as possible and preferable.
Please do keep me posted!



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---------- FOLLOW-UP ----------

QUESTION: My daughter saw the neurologist today, unfortunately he was not very helpful. He acted as if she was overreacting and this mass/lesion was nothing to be concerned about. He finally ordered an MRI. Needless to say, we are confused and concerned that he seemed so dismissive. He did not feel a biopsy was in order. She did not feel comfortable with him and we will find another doctor to review the MRI results. Do you have any suggestions?  

Answer
I'm surprised too. Only a biopsy can with certainty tell what this is. Please let me know the result of the MRI and get a second opinion from a NEUROSURGEON!


You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128     There is no restriction to the number of questions there.