Description
Clinical History
A 29-year old male presented with a 22 month history of headaches and blurred vision. Examination revealed a bi-temporal hemianopia and a left VI nerve palsy. Skull X-ray showed erosion of most of the sphenoid body with some dorsum sellae and anterior clinoid process intact. Carotid angiography showed upward and lateral displacement of the anterior and middle cerebral arteries. Pneumoencephalography (a common imaging procedure used until the 1970s in which CSF is drained and replaced by air, oxygen or helium that acted as a contrast medium in X-ray examinations) showed upward displacement of the lateral and third ventricles from below. A craniotomy was performed but the patient died immediately afterwards.
Pathology
The brain specimen is sliced in the sagittal plane to the right of the falx cerebri, which remains in-situ. The pituitary gland has been completely replaced by a round tumor 4cm in maximum diameter. The tumor cut surface is pale brown and homogenous (except for an area of hemorrhage superiorly, likely caused by surgical trauma). The tumor has resulted in upward displacement of the midbrain. Tumor erosion has destroyed the sphenoid bone; thus, the sella turcica is enlarged (arrow). The optic chiasma is compressed by the tumor. Histologically, this tumor was a chromophobe adenoma arising from the anterior pituitary.
Further Information
This specimen is from an old case and the investigations used would now be considered antiquated. Modern investigation would include an initial brain CT followed by an MRI of the brain to further visualize the pituitary lesion prior to any surgical intervention.
Pituitary adenomas are the most common pituitary tumor and are most commonly found in adults with peak incidence between 35-60 years. Primary carcinoma of the pituitary is very rare, and the pituitary is an uncommon site for metastases. Clinical manifestations of pituitary adenomas are related to local mass effect and tumor function. Local effects include increasing intracranial pressure (headache, nausea and vomiting), sellar expansion, bony erosion and compression of decussating nerve fibers in the optic chiasma, causing bitemporal hemianopia.
Pituitary adenomas can be functioning (i.e. associated with hormone excess) or non-functioning (i.e. without clinical symptoms of hormone excess). About 75% of adenomas are functional: usually secreting prolactin, growth hormone or ACTH. Secretion of TSH, LH and FSH from pituitary adenomas is very rare. Some adenomas can secrete two hormones: growth hormone and prolactin being the most common combination. Non-functional pituitary adenomas come to clinical attention later than those associated with endocrine abnormalities, and they may lead to hypopituitarism due to compression atrophy of the surrounding normal gland.
Advantages
- Anatomically accurate and identical to real specimen
- No ethical issues - not real human body parts
- Reasonably priced
- Available within a short lead time
- Reproducible, several identical prints can be used as a classroom set
- Can be produced in different sizes to cater for the needs of the teacher
Human Cadavers
- Access to cadavers can be problematic. Many countries cannot access cadavers for cultural and religious reasons
- Cadavers cost a lot money
- High cost for establishing your own plastination suite
- Wet specimens cannot be used in uncertified labs
- Dissection of cadavers is a lot of staff time and that is a cost
- Storage of cadaver material needs special refrigeration etc. which has coast
- If you want another specimen you have to start all over again
Plastinates
- Costs
- Ethical issues
- Timeframe for plastination process
- Many countries do not allow their importation
- One of a kind
Superior 3D print results compared with conventional methods
- Vibrant color offering with 10 million colors
- UV-curable inkjet printing
- High quality 3D printing that can create products that are delicate, extremely precise and incredibly realistic
Clear Support Material
- To avoid breakage of fragile, thin, and delicate arteries, veins or vessels, a clear support material is printed on such spots. This makes the models robust and can be handled by students easily.
