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Yohan Alexander A, Michalopoulos G, Kerezoudis P, Van Gompel JJ, Link MJ, Peris-Celda M. Treatment modalities and outcomes of granular cell tumors and spindle cell oncocytomas of the pituitary gland: an analysis of two national cancer databases. Acta Neurochir (Wien) 2024; 166:169. [PMID: 38578465 DOI: 10.1007/s00701-024-06054-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Spindle cell oncocytomas (SCO) and granular cell tumors (GCT) are rare primary pituitary neoplasms; the optimal treatment paradigms for these lesions are unknown and largely unexplored. Thus, using national registries, we analyze the epidemiology, management patterns, and surgical outcomes of SCOs and GCTs. METHODS The National Cancer Database (NCDB; years 2003-2017) and the Surveillance, Epidemiology, and End Results Program (SEER; years 2004-2018) were queried for patients with pituitary SCOs or GCTs. Incidence, extent of surgical resection, and rate of postoperative radiation use for subtotally resected lesions comprised the primary outcomes of interest. All-cause mortality was also analyzed via time-to-event Kaplan-Meier curves. RESULTS SCOs and GCTs have an annual incidence of 0.017 and 0.023 per 1,000,000, respectively. They comprise 0.1% of the benign pituitary tumors registered in NCDB. A total of 112,241 benign pituitary tumors were identified in NCDB during the study period, of which 83 (0.07%) were SCOs and 59 (0.05%) were GCTs. Median age at diagnosis was 55 years, 44% were females, and median maximal tumor diameter at presentation was 2.1 cm. Gross total resection was achieved in 54% patients. Ten patients (7%) had postoperative radiation. Comparing patients with GCTs versus SCOs, the former were more likely to be younger at diagnosis (48.0 vs. 59.0, respectively; p < 0.01) and female (59% vs. 34%, p = 0.01). GCTs and SCOs did not differ in terms of size at diagnoses (median maximal diameter: 1.9 cm vs. 2.2 cm, respectively; p = 0.59) or gross total resection rates (62% vs. 49%, p = 0.32). After matching SCOs and GCTs with pituitary adenomas on age, sex, and tumor size, the former were less likely to undergo gross total resection (53% vs. 72%; p = 0.03). Patients with SCOs and GCTs had a shorter overall survival when compared to patients with pituitary adenomas (p < 0.01) and a higher rate of thirty-day mortality (3.1% vs 0.0%; p = 0.013). CONCLUSION SCOs and GCTs are rare pituitary tumors, and their management entails particular challenges. Gross total resection is often not possible, and adjuvant radiation might be employed following subtotal resection.
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Affiliation(s)
- A Yohan Alexander
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Medical School, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Maria Peris-Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA.
- Department of Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Castellanos LE, Gutierrez C, Smith T, Laws ER, Iorgulescu JB. Epidemiology of common and uncommon adult pituitary tumors in the U.S. according to the 2017 World Health Organization classification. Pituitary 2022; 25:201-209. [PMID: 34580820 DOI: 10.1007/s11102-021-01189-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To examine the contemporary epidemiology of adult pituitary tumors with a particular focus on uncommon tumor types, using the 2017 WHO Classification of pituitary tumors. METHODS Adult patients presenting with a pituitary or sellar tumor between 2004 and 2017 were identified from the U.S. National Cancer Database, with tumor type categorized according to the 2017 WHO classification. Descriptive epidemiological statistics were evaluated and reported for all pituitary tumor types and subtypes. RESULTS 113,349 adults with pituitary tumors were identified, 53.0% of whom were female. The majority of pituitary tumors were pituitary adenomas (94.0%), followed by craniopharyngiomas (3.8%). Among pituitary adenomas, whereas 71.6% of microadenomas presented in females, only 46.7% of macroadenomas and 41.3% of giant adenomas did (p < 0.001). For craniopharyngiomas, 71.2% were adamantinomatous and 28.8% were papillary, with adamantinomatous tumors associated with Black non-Hispanic race/ethnicity (ORadj = 2.44 vs. White non-Hispanic, 99.9 %CI = 1.25-4.75, p < 0.001) in multivariable analysis. The remaining 0.7% (n = 676) of pathology-confirmed pituitary tumor types were composed of: 21% tumors of the posterior pituitary, 16% chordomas, 11% pituitary carcinomas (i.e. adenohypophyseal histology with metastasis; herein most frequently to bone), 10% meningiomas, 8% germ cell tumors, 7% hematolymphoid (largely DLBCLs), and 4% neuronal/paraneuronal (largely gangliogliomas). Pituitary carcinomas and posterior pituitary tumors demonstrated a male predilection (62.2% and 56.0%, respectively), whereas sellar meningiomas predominated in females (84.1%). Age, race/ethnicity, tumor size, and overall survival further varied across uncommon pituitary tumor types. CONCLUSIONS Our findings provide a detailed contemporary dissection of the epidemiology of common and uncommon adult pituitary tumors in the context of WHO2017.
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Affiliation(s)
- Luz E Castellanos
- Division of Pediatric Endocrinology, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Timothy Smith
- Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Pituitary and Neuroendocrine Center, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's, Boston, MA, USA
| | - Edward R Laws
- Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Pituitary and Neuroendocrine Center, Brigham and Women's Hospital, Boston, MA, USA
| | - J Bryan Iorgulescu
- Harvard Medical School, Boston, MA, USA.
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's, Boston, MA, USA.
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, 75 Francis St., Boston, MA, 02115, USA.
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Chen B, Fan X, Zhang Z. Pituicytoma: Report of three cases and a systematic literature review. Clin Neurol Neurosurg 2021; 205:106650. [PMID: 33971477 DOI: 10.1016/j.clineuro.2021.106650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/08/2021] [Accepted: 04/10/2021] [Indexed: 01/19/2023]
Abstract
Pituicytoma is a rare subtype of WHO grade I glioma that originates in the neurohypophysis or infundibulum. Here we presented 3 cases of histopathologically diagnosed pituicytoma and subsequently performed a corresponding systematic literature review. A comprehensive literature search of the PubMed database was conducted. A total of 77 studies were eventually reviewed and 168 pituicytoma cases were identified. The epidemiology, clinical manifestations, radiological features, treatment, and pathological findings of all previous pituicytoma cases were summarized, and a "portrait" of this rare tumor was shown. It is hoped that the current study will afford a broader and more adequate understanding upon this rare disease.
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Affiliation(s)
- Baoshi Chen
- Department of Neurosurgery, Beijing Tiantan hospital, Capital Medical University, 119 South Fourth Ring West Road, Fengtai District, Beijing 100070, China
| | - Xing Fan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, China
| | - Zhong Zhang
- Department of Neurosurgery, Beijing Tiantan hospital, Capital Medical University, 119 South Fourth Ring West Road, Fengtai District, Beijing 100070, China.
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Das L, Vaiphei K, Rai A, Ahuja CK, Singh P, Mohapatra I, Chhabra R, Bhansali A, Radotra BD, Grossman AB, Korbonits M, Dutta P. Posterior pituitary tumours: patient outcomes and determinants of disease recurrence or persistence. Endocr Connect 2021; 10:387-400. [PMID: 33709954 PMCID: PMC8142326 DOI: 10.1530/ec-20-0621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/11/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Posterior pituitary tumours (PPTs) are rare neoplasms with the four recognised subtypes unified by thyroid transcription factor -1 (TTF-1) expression, according to the 2017 WHO classification. Though traditionally defined as low-grade neoplasms, a substantial proportion of them show recurrence/persistence following surgery. METHODS We selected patients with PPTs in our cohort of 1760 patients operated for pituitary tumours over the past 10 years (2010-2019). The clinical, radiological, hormonal, histopathological profiles and long-term outcomes of the three cases identified (two pituicytomas and one spindle cell oncocytoma, SCO) were analysed. Following a literature review, data of all published cases with documented TTF-1 positive pituicytomas and SCOs were analysed to determine the predictors of recurrence/persistence in these tumours. RESULTS Patients presented with compressive features or hypogonadism. Two had sellar-suprasellar masses. One had a purely suprasellar mass with a pre-operative radiological suspicion of pituicytoma. Two were operated by transsphenoidal surgery and one transcranially guided by neuronavigation. Histopathology confirmed spindle cells in a storiform arrangement and low Ki67 index. Immunohistochemistry showed positive TTF-1, S-100 expression and variable positivity for EMA, vimentin and GFAP. Re-evaluation showed recurrence/persistence in two patients. A literature review of recurrent/persistent pituicytoma (n = 17) and SCO (n = 9) cases revealed clinical clues (headache for pituicytomas, male gender for SCO), baseline tumour size (≥20.5 mm with sensitivity exceeding 80%) and longer follow-up duration as determinants of recurrence/persistence. CONCLUSION PPTs are rare sellar masses with quintessential TTF-1 positivity. Recurrent/persistent disease following surgery is determined by greater tumour size at baseline and duration of follow-up. This warrants intensive and long-term surveillance in these patients.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India
| | - Kim Vaiphei
- Department of Histopathology, PGIMER, Chandigarh, India
| | - Ashutosh Rai
- Department of Translational and Regenerative Medicine, PGIMER, Chandigarh, India
| | | | | | - Ishani Mohapatra
- Department of Pathology and Laboratory Medicine, Medanta, The Medicity, Gurgaon, India
| | | | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India
| | | | - Ashley B Grossman
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Green Templeton College, University of Oxford, Oxford, UK
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Pinaki Dutta
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India
- Correspondence should be addressed to P Dutta:
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Hong CS, Elsamadicy AA, Fisayo A, Inzucchi SE, Gopal PP, Vining EM, Erson-Omay EZ, Bulent Omay S. Comprehensive Genomic Characterization of A Case of Granular Cell Tumor of the Posterior Pituitary Gland: A Case Report. Front Endocrinol (Lausanne) 2021; 12:762095. [PMID: 34925233 PMCID: PMC8671743 DOI: 10.3389/fendo.2021.762095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Granular cell tumors of the pituitary belong to a rare family of neoplasms, arising from the posterior pituitary gland. Although considered benign, they may cause significant morbidity and residual disease after resection can lead to poor clinical outcomes. Currently, there is no known medical therapy for any posterior pituitary gland tumor, in part due to sparse molecular characterization of these lesions. We report data from whole exome sequencing of a case of granular cell tumor of the pituitary, performed under an institutional review board approved protocol. A 77 year-old female underwent resection of an incidentally diagnosed pituitary mass that was causing radiographic compression of the optic nerves with a subclinical temporal field defect and central hypothyroidism. The pathology of the resected specimen demonstrated a granular cell tumor of the posterior pituitary gland. Whole-exome sequencing revealed mutations predicted to be deleterious in key oncogenes, SETD2 and PAX8, both of which have been described in other cancers and could potentially be amenable to targeted therapies with existing approved drugs, including immune checkpoint inhibitors and histone deacetylase inhibitors, respectively. To our knowledge, this is the first comprehensive genomic characterization of granular cell tumor of the posterior pituitary gland. We report mutations in oncogenes predicted to be deleterious and reported in other cancers with potential for therapeutic targeting with existing pharmacologic agents. These data provide new insights into the molecular pathogenesis of GCT of the pituitary and may warrant further investigation.
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Affiliation(s)
- Christopher S. Hong
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, United States
| | | | - Adeniyi Fisayo
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, United States
| | - Silvio E. Inzucchi
- Section of Endocrinology, Department of Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Pallavi P. Gopal
- Department of Pathology, Yale School of Medicine, New Haven, CT, United States
| | - Eugenia M. Vining
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - E. Zeynep Erson-Omay
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, United States
- *Correspondence: E. Zeynep Erson-Omay, ; Sacit Bulent Omay,
| | - Sacit Bulent Omay
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, United States
- *Correspondence: E. Zeynep Erson-Omay, ; Sacit Bulent Omay,
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Rubino F, Martinez-Perez R, Vieira S, Voscoboinik DS, Mural M, Orr AJ, Hardesty DA, Carrau RL, Prevedello DM. Granular cell tumors of the sellar region: what should be done after subtotal resection? A systematic review. Pituitary 2020; 23:721-732. [PMID: 32740679 DOI: 10.1007/s11102-020-01068-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Granular cell tumors (GCT) are highly vascularized and adherent to adjacent structures, and so, complete resection represents a challenge. Adjuvant therapy decisions for residual GCTs currently relies on individual clinician decisions due to a paucity of systematic literature data. We present a comprehensive analysis about the impact of adjuvant therapy in reported cases of patients with incomplete GCT resection. METHODS One database (PubMed) and crossed references were queried for GCT with incomplete resection or biopsy from 1962 to 2020. Literature review was performed according to the PRISMA guidelines. Also, two patients with residual GCT from our institutions are added to the analysis. Data regarding clinical presentation, surgical approach, use of adjuvant therapy, Ki-67 labeling, and follow up assessments were extracted and analyzed from selected publications. RESULTS Thirty-three studies met the predetermined inclusion criteria and 53 patients were selected (including our two reported cases). The median of age was 49 [IQR, 39-60 years], with a slight male predominance (1.2:1). Among the surgical procedures, seven (13%) were biopsies alone. Adjuvant therapy was used in 18 patients (radiotherapy, 94.5%; chemotherapy, 5.5%) but there is no statistical correlation with adjuvant therapy and the progression of the remnant tumor (p = 0.33). Our institutions' patients did not receive adjuvant therapy and did not show tumor progression on MRI. CONCLUSION Our systematic literature review suggests there is a limited role for chemo and/or radiotherapy in the management of incomplete GCT resection. It may be reasonable recommending close clinical follow up in patients with incomplete resection.
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Affiliation(s)
- Franco Rubino
- Department of Neurological Surgery, Hospital Nacional Posadas, Buenos Aires, Argentina
| | - Rafael Martinez-Perez
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, N-1049 Doan Hall, Columbus, OH, 43210, USA
| | - Samuel Vieira
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, N-1049 Doan Hall, Columbus, OH, 43210, USA
| | | | - Miguel Mural
- Department of Neurological Surgery, Hospital Nacional Posadas, Buenos Aires, Argentina
| | - Anna J Orr
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, N-1049 Doan Hall, Columbus, OH, 43210, USA
| | - Douglas A Hardesty
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, N-1049 Doan Hall, Columbus, OH, 43210, USA
- Department of Otolaryngology Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Ricardo L Carrau
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, N-1049 Doan Hall, Columbus, OH, 43210, USA
- Department of Otolaryngology Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Daniel M Prevedello
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, N-1049 Doan Hall, Columbus, OH, 43210, USA.
- Department of Otolaryngology Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
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Whipple SG, Savardekar AR, Rao S, Mahadevan A, Guthikonda B, Kosty JA. Primary Tumors of the Posterior Pituitary Gland: A Systematic Review of the Literature in Light of the New 2017 World Health Organization Classification of Pituitary Tumors. World Neurosurg 2020; 145:148-158. [PMID: 32916355 DOI: 10.1016/j.wneu.2020.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The rare clinical entity of primary posterior pituitary tumors (PPTs) includes pituicytomas, granular cell tumors, spine cell oncocytomas, and sellar ependymomas. The recent World Health Organization classification of PPTs based on thyroid transcription factor 1 positivity has led to more investigations into the epidemiology, clinical presentation, nature history, histologic features, and operative characteristics of these tumors. The aim of this review is to summarize the characteristics of primary PPTs. METHODS Our summary involved an in-depth review of the literature on PPTs. Our systematic review was carried out using the PubMed database and PRISMA guidelines. RESULTS An initial search identified 282 publications. After strict application of the inclusion criteria, we found 16 articles for case series of patients with primary PPT (N > 5), which were included in our table for literature review. An additional 10 articles were review articles on PPTs published in the last 20 years and were used as resource for our systematic review. An extensive analysis was then performed to extract relevant clinical data with respect to the clinical radiologic histopathologic profile of primary PPTs and their treatment outcome. CONCLUSIONS Primary PPTs are a rare group of pituicyte-derived low-grade nonneuroendocrine neoplasms that arise from the sellar region. The nondescript radiographic findings and subtle endocrine abnormalities also veil their accurate diagnostic prediction. As shown through the narrative as well as the literature review, there is still a lot to be understood about PPTs. A prospective multicenter registry of these rare tumors would benefit both the neurosurgical as well as the endocrinologic knowledge base.
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Affiliation(s)
- Stephen Garrett Whipple
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Amey R Savardekar
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bharat Guthikonda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Jennifer A Kosty
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
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