Cadaveric case analysis of primary empty sella with clinical literature review of empty sella syndrome

Introduction

An empty sella anatomical finding is characterized by the pituitary gland (hypophysis) being flattened against the wall of the sella turcica (hypophyseal fossa). Many neurologic and endocrinologic symptoms can ensue from pituitary gland deformity, resulting in empty sella syndrome (ESS) which is often diagnosed via computed tomography that showing the apparent “empty sella.” Gross cadaveric imaging and histological analysis of empty sella findings are scarcely reported in the literature but may help understand the condition. The objective of this study is to investigate a cadaveric case of complete primary empty sella (PES) with gross imaging, histological analysis, and a comprehensive clinical review.

Methods

An empty sella finding was discovered during routine dissection of the basicranium in an elderly male human cadaver obtained from an ethically approved body donor program. The case was photographed in situ from multiple viewpoints. The head was sectioned in the midsagittal plane and photographed with scale to show the morphology of the remnant pituitary gland. Consistent dissections, photographs, and measurements were performed on another cadaver with typical pituitary anatomy for side-by-side comparison. Histological analysis was performed on the compressed pituitary gland and examined via light microscopy.

Results

Gross examination of this empty sella case revealed a characteristic complete PES due to herniation of cerebrospinal fluid (CSF) through a collapsed diaphragma sellae. Despite the significant compression and reduction of pituitary gland volume, its tissue organization and cell characteristics remained proportionally consistent with typical pituitary tissue. The cadaver's age (90+ years) and sex (male) made for unique and valuable clinical discussion.

Conclusions

The present case offers a thorough analysis of an empty sella case, uniquely including gross anatomy photos, histological examination, and a thorough review of clinical implications regarding the rarity of a complete PES in an advanced-aged male individual. This report serves to provide important clinical insights to anatomists, neurologists, endocrinologists, and medical educators about empty sella clinical implications.