Treatment and prognostic factors of pituicytoma: a single-center experience and comprehensive literature review

Preoperatively Predicting Ki67 Expression in Pituitary Adenomas Using Deep Segmentation Network and Radiomics Analysis Based on Multiparameter MRI

RATIONALE AND OBJECTIVES

Ki67 proliferation index is associated with more aggressive tumor behavior and recurrence of pituitary adenomas (PAs). Recently, radiomics and deep learning have been introduced into the study of pituitary tumors. The present study aimed to investigate the feasibility of predicting the Ki67 proliferation index of PAs using the deep segmentation network and radiomics analysis based on multiparameter MRI.

MATERIALS AND METHODS

First, the cfVB-Net autosegmentation model was trained; subsequently, its performance was evaluated in terms of the dice similarity coefficient (DSC). In the present study, 1214 patients were classified into the high Ki67 expression group (HG) and the low Ki67 expression group (LG). Analyses of three classification models based on radiomics features were performed to distinguish HG from LG. Clinical factors, imaging features, and Radscores were collectively used to create a nomogram in order to effectively predict Ki67 expression.

RESULTS

The cfVB-Net segmentation model demonstrated good performance (DSC: 0.723-0.930). Overall, 18, 15, and 11 optimal features in contrast-enhanced (CE) T1WI, T1WI, and T2WI were obtained for differentiating between HG and LG, respectively. Notably, the best results were presented in the bagging decision tree when CE T1WI and T1WI were combined (area under the receiver operating characteristic curve: training set, 0.927; validation set, 0.831; and independent testing set, 0.825). In the nomogram, age, Hardy' grade, and Radscores were identified as risk predictors of high Ki67 expression.

CONCLUSION

The deep segmentation network and radiomics analysis based on multiparameter MRI exhibited good performance and clinical application value in predicting the expression of Ki67 in PAs.

Surgical approach to the treatment of pituicytoma. Report of five cases and a literature review

Background

Pituicytoma (PTs) is a rare tumor of the sella and suprasellar region, derived from the pituicytes of the neurohypophysis, having distinct histological characteristics of glial neoplasms. We reported, the clinical data, neuroimaging studies, surgical approaches and pathology in five patients with PTs and also, we reviewed the literature.

Methods

Retrospective chart from five consecutive patients with PTs treated at one University Hospital from 2016 to 2021 were reviewed. In addition, we conducted a search in PubMed/Medline databases using the term "Pituicytoma". Data regarding age, gender, pathological findings, and treatment modality applied were extracted.

Results

All patients were female, aged 29-63, complaining of headaches, visual loss and field defects, dizziness and normal or abnormal levels of circulating pituitary hormones. Magnetic Resonance Imaging (MRI) showed in all patients a sellar and suprasellar mass, which was removed through an endoscopic transsphenoidal approach. Our third patient had a subtotal resection followed by close observation. Histopathology showed a glial non-infiltrative tumors with spindle cells, and a final diagnosis of pituicytoma was made. After surgery, visual field defects in all patients were normalized, and in two patients normal levels of plasma hormones were restored. After a mean of three years follow-up, the patients were managed post-operatively through close clinical observation and serial MRI. None of the patients had recurrence of the disease.

Conclusion

PTs is a rare glial tumor of the sellar and suprasellar region that arises from neurohypophyseal pituicytes. Disease control may be achieved by total excision.

Pituicytoma: A rare tumor of the sella. A case report and review of literature for diagnosis and management

Background

Pituicytomas are rare tumors of the pituitary gland derived from the ependymal cells and line the pituitary stalk and posterior lobe. These tumors are located in the vulnerable regions of the brain: Either in the sellar or suprasellar area. The location marks the difference in the clinical features of the tumor. Here, we report a case of histopathologically diagnosed pituicytoma of the sellar region. Literature is also reviewed and discussed to gain a better understanding of this rare disease.

Case Description

A 24-year-old female presented to the outpatient department with complaints of headache, diplopia, dizziness, and decreased vision in the right eye for 6 months. Computed tomography scan brain without contrast showed a well-defined hyperdense lesion in the sella without associated bony erosion. Her magnetic resonance imaging showed well defined rounded lesion in the pituitary fossa which was isointense on T1-weighted image and hyperintense on T2-weighted images. A presumptive diagnosis of pituitary adenoma was made. She underwent endoscopic endonasal transsphenoidal resection of pituitary mass. Intraoperatively, normal pituitary gland was visualized and there was a grayish-green-colored, jelly like tumor which was pulled gently. On 9^th postoperative day, she presented with cerebrospinal fluid (CSF) rhinorrhea. She underwent endoscopic CSF leak repair. Her histopathology was concluded to be Pituicytoma.

Conclusion

Pituicytoma is an uncommon diagnosis. The surgical aim is to completely excise the tumor which results in complete cure, but incomplete resection may be performed due to high vascularity of this tumor. In case of incomplete excision, recurrence is common and adjuvant radiotherapy may be administered.

Pituicytoma: A rare case report of sellar and suprasellar tumor

Introduction

Pituicytomas are low-grade glial tumors in the sellar and suprasellar region. They may be easily confused with pituitary lesions. We review the literature in order to better understand and categorize the natural history, clinical presentations, and treatments.

Presentation of case

A 45-year-old female patient who complained of left eye blurred vision for 2 months. The imaging study revealed a solid sellar tumor with marked homogeneous enhancement following intravenous administration of gadolinium, and compression of the optic chiasm. Thus, under the preoperative diagnosis of pituitary macroadenoma, the patient underwent endoscope-assisted surgery via the transsphenoidal approach. The patient recovered well after surgery. The histopathological diagnosis was pituicytoma, WHO grade I.

Clinical discussion

Pituicytomas are defined as a circumscribed low-grade glial tumor arising from the neurohypophysis or infundibulum with bipolar spindle cells arranged in a fascicular or storiform pattern (a cartwheel). The clinical symptoms are variable depending on the tumor size and location. They usually present due to mass effect. The radiographic characteristics are not nonspecific. The diagnosis of pituicytoma is based on histopathological evidence. Pituicytomas consist of a solid proliferation of elongated spindle cells arranged in interlacing fascicles and/or in a “storiform” pattern. In immunohistochemical studies, pituicytomas was strongly expressed in TTF-1.

Conclusion

Pituicytomas are benign, slow-growing glial tumors. It is difficult to diagnosed before operation as its clinical presentations and imaging studies resemble those of non-functional pituitary adenomas. The best chance of successful treatment is gross total resection by the endoscopic approach or transcranial approach.

•

Pituicytomas are rare benign tumors arising from the neurohypophysis or infundibulum.

•

They are often mistaken for pituitary adenomas which have a similar clinical presentations and imaging findings.

•

The diagnosis of pituicytoma is based on histopathological evidence. In immunohistochemical studies, pituicytomas was strongly expressed in TTF-1.

•

Complete resection of the tumor is the main treatment for pituicytoma. The choice of surgical route used may depended on the tumor size, whether invasion to other structures has occurred, and the technique of the surgeon.

Pituicytoma Associated with Suspected Cushing’s Disease: Two Case Reports and a Literature Review

(1) Background: Pituicytomas are rare gliomas located in the neurohypophysis or infundibulum. A misdiagnosis of pituicytoma as pituitary adenoma is common because of similar location and occasional endocrine disturbances. (2) Case presentation: We present two cases with the comorbidity of pituicytoma and Cushing’s disease (CD). Case 1 is that of a 51-year-old woman, the first reported case of the comorbidity of pituicytoma, CD, and central diabetes insipidus. She received a diagnosis of CD and central diabetes insipidus. After transsphenoidal surgery, histopathology confirmed the diagnosis of pituicytoma and adrenocorticotropin-secreting microadenoma; case 2 is that of a 29-year-old man who received a biochemical diagnosis of CD, but he received a histopathological confirmation of only pituicytoma. Both patients achieved a remission of hypercortisolism without relapse during the follow-up, but they developed hypopituitarism after surgery. We also reviewed all published 18 cases with the comorbidity of pituicytoma and any pituitary adenoma. (3) Conclusions: Pituicytoma might present pituitary hyperfunction disorders such as CD or acromegaly, with or without pathologically confirmed pituitary adenoma. CD is the most common hyperpituitarism occurring concurrently with pituicytomas. The remission rate and hypopituitarism after surgery seem similar or slightly lower in CD than in common pituitary adenomas, but the long-term prognosis is unexplored.

Surgical management of pituicytomas: a single-center case series

OBJECTIVE

Pituicytomas (PT) are rare benign sellar and/or supra sellar tumors which surgical treatment might be challenging, owing to the hypervascularity of the tumor. Here, we report our experience with PTs, describe their clinical and radiological features, and propose an optimal therapeutic strategy.

METHODS

This is a retrospective single-center study, reporting the clinical manifestations, radiological characteristics, histopathological features, treatment strategies and long-term outcomes of four patients who have been treated for a PT at Bicêtre University Hospital in Paris, France, over the past 7 years.

RESULTS

Four patients were operated mean age at presentation was 60.25 years. Main symptoms, which tended to be progressive, included visual field defects and pituitary-hypothalamic dysfunction. Radiologically, all our cases resented with sellar and suprasellar localization with cavernous invasion in 75% of cases. Endoscopic transphenoidal approach was performed as first surgery for all cases. Transcranial route was done in one case. During surgery, important bleeding was observed in all cases. Gross total resection was obtained with a single surgery in two cases and a second surgery was necessary in the two remaining cases. Pathological diagnosis was confirmed in all cases. No recurrences were noted after an average follow-up of 3.6 years.

CONCLUSIONS

PT is a rare differential diagnosis of sellar and/or parasellar tumors, whose hemorrhagic nature can become a challenge during surgery. We added four more cases to the literature to make physicians establish Piticytomas at suspicion diagnosis for sellar and/or suprasellar masses. Knowing the diagnosis, a preparation should be made preoperatively to avoid possible complications peroperatively.