A pituitary adenoma with dilated ventricles

It is generally accepted that postoperatively radiographic examinations be limited to the area of pathology. The patient presented here complained of visual difficulties two years after transphenoidal removal of a pituitary prolactinoma. His endocrinologist ordered what he believed to be the appropriate computed tomography study and the neuroradiologist did not correctly interpret the new finding of dilated ventricles. Subsequently, a second primary tumor was discovered, a pineal gland sarcoma. The patient had refused radiotherapy after removal of his prolactinoma. Had he not, his second tumor would probably have been attributed to radiation. It is interesting to speculate whether radiation scatter from treatment of the prolactinoma would have prevented the pineal gland sarcoma.