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Bhat R, Shankar N, Lu C, Srinivasa R, Rao S, Kalra P. A Rare Pituitary Tumor. Cureus 2024; 16:e63264. [PMID: 39070413 PMCID: PMC11281943 DOI: 10.7759/cureus.63264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/30/2024] Open
Abstract
Sellar-suprasellar masses, with diverse origins ranging from infiltrative to neoplastic processes, are frequently encountered in endocrinology clinics. Evaluation involves a detailed history, hormone analysis, and imaging of the hypothalamic-pituitary axis. However, overlapping hormonal and imaging features can complicate diagnosis, often necessitating confirmation through tissue biopsy. Pituicytoma, a rare sellar tumor mimicking other masses biochemically and radiologically, exemplifies this challenge. These are benign intracranial neoplasms with characteristic bipolar spindle-shaped astrocytic cells organized in fascicular or storiform patterns with specific immunohistochemistry. The current case is of an elderly postmenopausal woman with a history of hypertension who presented with recurrent headaches and transient vision loss in the left eye. Imaging studies revealed a suprasellar mass, which was biopsied and diagnosed on histopathological examination as a pituicytoma. This case highlights the importance of considering less common etiologies when encountering such presentations.
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Affiliation(s)
- Ramya Bhat
- Internal Medicine, Mathikere Sampige (M S) Ramaiah Medical College Hospital, Bangalore, IND
| | - Nikhil Shankar
- Internal Medicine, Mathikere Sampige (M S) Ramaiah Medical College Hospital, Bangalore, IND
| | - Chirag Lu
- Endocrinology, Diabetes and Metabolism, Ramaiah Medical College, Bangalore, IND
| | - Rakshith Srinivasa
- Neurosurgery, Mathikere Sampige (M S) Ramaiah Medical College Hospital, Bangalore, IND
| | - Shilpa Rao
- Neuropathology, National Institute of Mental Health & Neurosciences, Bangalore, IND
| | - Pramila Kalra
- Endocrinology and Metabolism, Mathikere Sampige (M S) Ramaiah Medical College Hospital, Bangalore, IND
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Yasuda ME, Recalde R, Jalón P, Prost D, Golby A, Zaninovich R. Surgical approach to the treatment of pituicytoma. Report of five cases and a literature review. World Neurosurg X 2023; 19:100186. [PMID: 37026087 PMCID: PMC10070180 DOI: 10.1016/j.wnsx.2023.100186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/16/2023] [Indexed: 04/08/2023] Open
Abstract
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.
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Affiliation(s)
- Marcos Ezequiel Yasuda
- Department of Neurosurgy, Hospital de Clínicas “José de San Martín”, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- Corresponding author. Department of Neurosurgery, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina, 2351 Cordoba Ave, Buenos Aires, Buenos Aires, CP: C1120AAF, Argentina.
| | - Rodolfo Recalde
- Department of Neurosurgy, Hospital de Clínicas “José de San Martín”, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Pablo Jalón
- Department of Neurosurgy, Hospital de Clínicas “José de San Martín”, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Diego Prost
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, F-75013, Paris, France
| | - Alexandra Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States
- Harvard Medical School, Boston, MA, United States
- Department of Radiology, Brigham and Women's Hospital, Boston, United States
| | - Roberto Zaninovich
- Department of Neurosurgy, Hospital de Clínicas “José de San Martín”, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
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Zaki U, Shakeel AS, Rauf Y, Raza M. Pituicytoma: A rare tumor of the sella. A case report and review of literature for diagnosis and management. Surg Neurol Int 2023; 14:220. [PMID: 37404513 PMCID: PMC10316132 DOI: 10.25259/sni_248_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/13/2023] [Indexed: 07/06/2023] Open
Abstract
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 9th 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.
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Affiliation(s)
- Umaima Zaki
- Department of Neurosurgery, Patel Hospital, Karachi, Pakistan
| | | | - Yaseen Rauf
- Department of Neurosurgery, Patel Hospital, Karachi, Pakistan
| | - Muhammad Raza
- Department of Histopathology, Aga Khan University Hospital, Karachi, Pakistan
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Wee Z, Tang PY, Lai SH, Ang BT, Chandran SR. Co-existence of pituicytoma and corticotroph adenoma in a patient with Cushing's disease. Pathology 2023; 55:432-435. [PMID: 36351865 DOI: 10.1016/j.pathol.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Zongwen Wee
- Department of Endocrinology, Singapore General Hospital, Singapore.
| | - Po Yin Tang
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Siang Hui Lai
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Beng Ti Ang
- Department of Neurosurgery (Singapore General Hospital Campus), National Neuroscience Institute, Singapore
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Xiao T, Duan L, Chen S, Lu L, Yao Y, Mao X, Zhu H, Pan H. Pituicytoma Associated with Suspected Cushing’s Disease: Two Case Reports and a Literature Review. J Clin Med 2022; 11:jcm11164805. [PMID: 36013043 PMCID: PMC9410523 DOI: 10.3390/jcm11164805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/27/2022] Open
Abstract
(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.
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Affiliation(s)
- Tongxin Xiao
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
- Eight-Year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Lian Duan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
- Correspondence:
| | - Shi Chen
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Lin Lu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xinxin Mao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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Giridharan K, Unais Mohammed CT, Saranraj M, Balamurugan M. Pituicytoma: A Report of Two Cases and Literature Review. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0042-1750740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Introduction Pituicytoma is a rare form of primary benign tumor of the neurohypophysis and infundibulum. There have been 140 reported cases in world literature that could be found in our search. Here we discuss about the presentation, radiological features, treatment, histopathology, and immunohistochemical markers of two cases, along with a brief review of literature.
Case 1 A 48-year-old female presented with headache and painless visual loss for 4 years. Examination revealed bitemporal hemianopia and normal fundus. Hormonal profile was normal. Magnetic resonance imaging (MRI) showed 2.6 × 2.8 × 3.3 cm, thin-walled, cystic sellar and suprasellar lesions stretching the optic chiasm superiorly. Endoscopic transnasal, transsphenoidal gross total excision was done. Histopathological examination (HPE) and immunohistochemistry (IHC) were suggestive of pituicytoma.
Case 2 A 55-year-old male presented with intermittent headache and vomiting for 3 months. Examination was unremarkable. Hormonal profile was normal. MRI showed lobulated mass of size 1.4 × 1.9 × 2.0 cm, arising from anterior pituitary and extending to the suprasellar cistern. Lesion was hyperintense in T1-weighted and heterointense in T2-weighted images, and Fluid attenuated inversion recovery images (FLAIR) with homogenous contrast enhancement pushed the optic chiasm superiorly. Endoscopic transnasal partial excision of the lesion was done. HPE and IHC were suggestive of pituicytoma.
Discussion Total number of cases was 142, of which 71 were males (50%) and 71 were females (50%). Age ranged between 7 and 83 years (mean 49.2, median 48). Brain imaging was available in 110 cases. Size of the lesion varied from 4 to 72 mm (mean 27 mm). Location was either pure sellar (24.3%) or with extension into the suprasellar cistern (34.3%) and/or the cavernous sinuses (7.1%). Lesions in MRI were solid (84%) with few areas of cystic changes, while contrast enhancement of solid portion was in 92% (homogenous in 80% and heterogeneous in 20%) of the cases. One case showed features of hemorrhage while no case showed calcification. Treatment was primarily surgical (120 out of 130 cases): transsphenoidal excision in 70% of the cases and craniotomy and excision in 30%. Preoperative embolization of arterial feeders was done in two cases and postoperative radiation was given in one case. Gross total resection was done in 46.3%, subtotal resection in 40%, partial resection in 12.6%, and biopsy was done in 1.1% of the cases in the study. Follow-up ranged from 2 to 134 months (average 31.2, median 19). Recurrence or regrowth was documented in 23 patients, treatment in 18 patients, and resurgery was done in 12 cases, followed by radiotherapy in 5. In six cases, radiotherapy was used in isolation. Improvement in the visual deficit was seen in 26 patients, and remained unchanged in 3. Among the patients with preoperative endocrine dysfunction, 10 improved while 11 suffered a worsening. Ten patients had new postoperative endocrine alteration. Only one fatal case was registered.
Conclusion Pituicytoma is a rare World Health Organization grade I tumor of the sellar and suprasellar region, presenting with varied clinical, radiological, and hormonal features. Histopathology and immunohistochemistry form the mainstay in diagnosis. Surgical excision with transsphenoidal approach is ideal. Prognosis in general is good after surgical resection alone or in conjunction with radiotherapy.
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Affiliation(s)
- K Giridharan
- Department of Neurosurgery, Apollo Specialty Hospitals, Nandanam, Teynampet, Chennai, Tamil Nadu, India
| | - C. T Unais Mohammed
- Department of Neurosurgery, Apollo Specialty Hospitals, Nandanam, Teynampet, Chennai, Tamil Nadu, India
| | - M.K Saranraj
- Department of Neurosurgery, Apollo Specialty Hospitals, Nandanam, Teynampet, Chennai, Tamil Nadu, India
| | - Mangaleswaran Balamurugan
- Department of Neurosurgery, Apollo Specialty Hospitals, Nandanam, Teynampet, Chennai, Tamil Nadu, India
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Trifa A, Knafo S, Maatoug A, Militaru M, Copaciu R, Aghakhani N, Parker F. Surgical management of pituicytomas: a single-center case series. Acta Neurol Belg 2022:10.1007/s13760-022-01917-0. [PMID: 35301693 DOI: 10.1007/s13760-022-01917-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Amine Trifa
- Neurosurgery Department, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France.
- Neurosurgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia.
| | - Steven Knafo
- Neurosurgery Department, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- Medical School, University Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Ahmed Maatoug
- Neurosurgery Department, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- Neurosurgery Department, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Matei Militaru
- Neurosurgery Department, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Razvan Copaciu
- Neurosurgery Department, Foch Hospital, Suresnes, France
| | - Nozar Aghakhani
- Neurosurgery Department, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- Medical School, University Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Fabrice Parker
- Neurosurgery Department, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- Medical School, University Paris-Saclay, Le Kremlin-Bicêtre, France
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Grenier-Chartrand F, Barrit S, Racu ML, Luce S, Spitaels J, Sadeghi-Meibodi N, Lebrun L, Salmon I, Lefranc F, De Witte O. Dabrafenib monotherapy for a recurrent BRAFV600E-mutated TTF-1-positive posterior pituitary tumor. Acta Neurochir (Wien) 2022; 164:737-742. [PMID: 35029761 DOI: 10.1007/s00701-022-05109-w] [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: 09/20/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Abstract
Posterior pituitary tumors (PPT) expressing thyroid transcription factor-1 (TTF-1) are extremely rare low-grade neoplasms. The recent discovery of BRAF mutations in these tumors offers a potential alternative treatment using targeted therapies. We present the case of a 57-year-old female with recurrent BRAFV600E-mutated TTF-1-positive PPT treated with a BRAF inhibitor monotherapy (dabrafenib) leading to tumor regression. After 18 months of uninterrupted treatment, ongoing radiological tumor regression was observed and the patient remained asymptomatic without any significant adverse event. BRAF inhibitor is potentially a valuable treatment option for recurrent TTF-1-positive PPT with BRAF mutation.
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Affiliation(s)
- Flavie Grenier-Chartrand
- Department of Neurosurgery, Erasme Hospital, ULB, Route de Lennik, 808, 1070, Anderlecht, Belgium.
| | - Sami Barrit
- Department of Neurosurgery, Erasme Hospital, ULB, Route de Lennik, 808, 1070, Anderlecht, Belgium
| | - Marie Lucie Racu
- Department of Pathology, Erasme Hospital, ULB, Anderlecht, Belgium
| | - Sylvie Luce
- Department of Oncology, Erasme Hospital, ULB, Anderlecht, Belgium
| | - Julien Spitaels
- Department of Neurosurgery, Erasme Hospital, ULB, Route de Lennik, 808, 1070, Anderlecht, Belgium
| | | | - Laetitia Lebrun
- Department of Pathology, Erasme Hospital, ULB, Anderlecht, Belgium
| | - Isabelle Salmon
- Department of Pathology, Erasme Hospital, ULB, Anderlecht, Belgium
| | - Florence Lefranc
- Department of Neurosurgery, Erasme Hospital, ULB, Route de Lennik, 808, 1070, Anderlecht, Belgium
| | - Olivier De Witte
- Department of Neurosurgery, Erasme Hospital, ULB, Route de Lennik, 808, 1070, Anderlecht, Belgium
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Ha YS, Lee SE, Park SC, Ahn SY, Jung YY. A Rare Case of Pituicytoma Presenting Cystic Formation. Brain Tumor Res Treat 2021; 9:70-74. [PMID: 34725987 PMCID: PMC8561223 DOI: 10.14791/btrt.2021.9.e11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022] Open
Abstract
Pituicytoma is a rare solid benign tumor of the sellar and/or suprasellar region originating from the pituicytes of the neurohypophysis or infundibulum, which is not differentiated from a pituitary adenoma that is diagnosed mostly in the sellar and/or suprasellar region. In addition, cystic tumors are very rare and have not been reported due to their solid and hypervascular natures. A 33-year-old man presented with a chronic headache which exacerbated recently. MRI was performed and revealed a cystic tumor in the sellar and suprasellar regions with a small parenchymal island in the cyst compressing the optic chiasm. The endoscopic endonasal transsphenoidal approach was used to remove the tumor. Immunohistochemical staining was positive for thyroid transcription factor 1, S-100 protein, and glial fibrillary acidic protein. The pituicytoma was diagnosed based on histologic findings. The authors review herein the literature on clinical presentation, diagnosis, surgical management, and outcome.
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Affiliation(s)
- Young Soo Ha
- Department of Neurosurgery, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea.
| | - Soo Eon Lee
- Department of Neurosurgery, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Sung Choon Park
- Department of Neurosurgery, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Sung Yeol Ahn
- Department of Neurosurgery, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Yoon Yang Jung
- Department of Pathology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
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Parkhi M, Gupta K, Dhandapani S, Salunke P. Pituicytoma in a Young Male and Review of Literature. Neurol India 2021; 69:1870-1872. [PMID: 34979717 DOI: 10.4103/0028-3886.333522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Mayur Parkhi
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pravin Salunke
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Wei LD, Li C, Li D, Liu XJ, Li RT, Li LW, Wang JM, Zhou DB. Treatment and prognostic factors of pituicytoma: a single-center experience and comprehensive literature review. Pituitary 2021; 24:754-767. [PMID: 33982223 PMCID: PMC8416853 DOI: 10.1007/s11102-021-01152-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Preoperative diagnosis of pituicytomas is difficult, and management and prognostic factors remain ambiguous. The purpose of this study was to elucidate the radiological characteristics of pituicytoma, to assess the risk factors affecting tumor progression, and to propose the optimal treatment regimen based on comprehensive analysis. METHODS We reviewed the clinical data of 22 patients with pituicytoma confirmed pathologically in our institution. In addition, 93 cases of pituicytoma in the previous literature were recruited. The individual data of 115 patients were analyzed to evaluate the adverse factors affecting pituicytoma progression. RESULTS In the combined cohort, 3 of 61 patients who underwent gross-total resection (GTR) developed recurrence (4.9%); of the 54 patients who received non-GTR, 19 progressed (35.2%). Univariate and multivariate Cox regression analysis verified male gender (HR 2.855, 95% CI 1.008-8.089; p = 0.048), TS (transsphenoidal surgery; HR 3.559, 95% CI 1.015-12.476; p = 0.047), and non-GTR (HR 4.388, 95%CI 1.240-15.521; p = 0.022) were independent unfavorable factors for pituicytoma progression. A multivariate logistic regression model verified that tumor diameter ≥ 1.85 cm (OR 4.859, 95% CI 1.335-17.691; p = 0.016) was independent adverse factors for GTR. Compared with TS, OT (open transcranial) is more likely to have postoperative complications (OR 3.185, 95% CI 1.020-9.944; p = 0.046), especially vision deterioration (OR 37.267, 95% CI 4.486-309.595; p = 0.001). CONCLUSION Based on our findings, GTR was advocated as an optimal treatment for pituicytomas. However, in order to avoid damage to important structures, partial resection is acceptable. After that, adjuvant radiotherapy is recommended for male patients with high Ki-67 index, and the remaining patients can be followed up closely. When the tumor recurs or progresses, it is recommended to re-operate and remove the lesion completely as far as possible. If GTR is still not possible, postoperative radiotherapy for the residual tumor is recommended.
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Affiliation(s)
- Liu-Dong Wei
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Chao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Xing-Ju Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Run-Ting Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Lian-Wang Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Jun-Mei Wang
- Department of Neuropathology, Beijing Neurosurgical Institute, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
| | - Da-Biao Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
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12
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Cheng JH, Nie D, Li B, Gui SB, Li CZ, Zhang YZ, Cavallo LM, Zhao P. Clinical features, radiological profiles, pathological features and surgical outcomes of pituicytomas: a report of 11 cases and a pooled analysis of individual patient data. Mil Med Res 2021; 8:39. [PMID: 34210357 PMCID: PMC8252196 DOI: 10.1186/s40779-021-00332-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pituicytoma is an extremely rare low-grade glial tumor that is closely related to the neurohypophysis axis. Most studies of pituicytomas include only several cases. To better understand this disease, we reviewed a series of cases of pituicytomas. The diagnosis and treatment of pituicytoma must be further elucidated. METHODS Eleven patients with pituicytoma admitted to Beijing Tiantan Hospital from 2012 to 2019 were selected. The clinical features, including radiological and histological examination, surgical records and prognosis were reviewed. Sixty-eight other previously published cases of pituicytoma also were used to analyze the predictive factors for the results. The Cox regression model was used for univariate and multivariate analyses. RESULTS Our patients included 5 males (45.5%) and 6 females (54.5%), with a mean age of 49.3 years. The tumor was located in the suprasellar region in 5 patients (45.5%), intrasellar region in 4 patients (36.4%), and intrasellar-suprasellar region in 2 patients (18.2%). All patients were misdiagnosed with other common tumors in the sellar region before the operation. During the operation, gross total resection (GTR) of the tumor was achieved in 6 patients (54.5%), and subtotal resection (STR) was achieved in 5 patients (45.5%). The mean progression-free survival (PFS) time was 29.82 months. Tumor progression after surgical resection occurred in 4 patients (36.4%). Among them, 60.0% of the patients (cases 4, 5, 7) with STR experienced progression, while 16.7% of the patients (case 2) with GTR experienced progression. Combined with the 68 cases in the literature, GTR was an independent risk factor for PFS time (P < 0.05). CONCLUSIONS Pituicytomas are more common in middle-aged people and the sellar region. The clinical manifestations of pituicytomas are different, but no diagnostic clinical features have been identified other than an abnormally abundant blood supply. Currently, GTR is the best approach for the treatment of pituicytomas. More patients and longer follow-up periods were needed to further elucidate the biological features of pituicytomas.
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Affiliation(s)
- Jian-Hua Cheng
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Ding Nie
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Bin Li
- Department of Cell and Biology, Beijing Neurosurgical Institute, Beijing, 100070, China
| | - Song-Bai Gui
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Chu-Zhong Li
- Department of Cell and Biology, Beijing Neurosurgical Institute, Beijing, 100070, China
| | - Ya-Zhuo Zhang
- Department of Cell and Biology, Beijing Neurosurgical Institute, Beijing, 100070, China
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Universitá Degli Studi di Napoli Federico II, 80142, Naples, Italy
| | - Peng Zhao
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
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13
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Barresi V, Simbolo M, Gessi M, Rossi S, Caffo M, Eccher A, Angileri FF, Cannavò S, Brunelli M, Scarpa A. Clinical-Pathological, Immunohistochemical, and Genetic Characterization of a Series of Posterior Pituitary Tumors. J Neuropathol Exp Neurol 2021; 80:45-51. [PMID: 33212494 DOI: 10.1093/jnen/nlaa139] [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] [Indexed: 02/04/2023] Open
Abstract
Posterior pituitary tumors are supposed to represent the morphological spectrum of a single entity. Herein, we report the clinical-pathological, immunohistochemical, and genetic features of 5 spindle cell oncocytomas (SCOs), 3 pituicytomas, and 1 granular cell tumor (GCT). SCOs had the highest local invasiveness and affected older subjects. The 3 histotypes differed in the content of spindle cells (predominant in pituicytoma and absent in GCT), presence of lymphocytic infiltrate (in SCO and GCT, but not in the pituicytoma) and EMA/GFAP staining (negative in GCT; EMA-positive/GFAP-negative in 4/5 SCO and GFAP-positive in 3/3 pituicytomas). Three SCOs and 1 pituicytoma analyzed with next-generation sequencing had no mutations in 409 genes. However, 1 SCO had previously unreported homozygous deletion of CDKN2A/B and another of SMARCA4, SMARCB1, and NF2. All 3 SCOs had loss of heterozygosity of chromosome 1p, while the pituicytoma had chromosome 19 homozygous loss and chromosomes 10, 13q, and 18q loss of heterozygosity. Since 1p and 13q losses were previously reported in 1 pituicytoma and 1 SCO, respectively, our data demonstrate that posterior pituitary tumors share common genetic alterations. The possibility that posterior pituitary tumors are SMARCA4/SMARCB1-deficient should be kept in mind in the differential diagnosis toward other entities.
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Affiliation(s)
- Valeria Barresi
- From the Department of Diagnostics and Public Health, Section of Anatomic Pathology, University of Verona
| | - Michele Simbolo
- From the Department of Diagnostics and Public Health, Section of Anatomic Pathology, University of Verona
| | - Marco Gessi
- Neuropathology Unit, Division of Pathology, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Catholic University
| | | | - Maria Caffo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Neurosurgery, University of Messina, Messina
| | - Albino Eccher
- Unit of Anatomic Pathology, Department of Pathology and Diagnostics, Hospital Trust of Verona, Verona
| | - Filippo Flavio Angileri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Neurosurgery, University of Messina, Messina
| | - Salvatore Cannavò
- Department of Human Pathology of Childhood and Adulthood, University of Messina, Messina
| | - Matteo Brunelli
- From the Department of Diagnostics and Public Health, Section of Anatomic Pathology, University of Verona
| | - Aldo Scarpa
- ARC-Net Research Centre, University and Hospital Trust of Verona, Verona (AS), Italy
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14
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Diversity of Pathological Conditions Affecting Pituitary Stalk. J Clin Med 2021; 10:jcm10081692. [PMID: 33920036 PMCID: PMC8071026 DOI: 10.3390/jcm10081692] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/31/2021] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
Pituitary stalk lesions (PSL) are a very rare pathology. The majority of conditions affecting the infundibulum do not present with clinically apparent symptoms, what makes the diagnosis difficult. The recognition might be also complicated by the non-specific and transient characteristics of hormonal insufficiencies. In our study, we retrospectively analysed demographic, biochemical, and clinical long-term data of 60 consecutive, unselected adult patients (34 women and 26 men) with PSL diagnosed in the Department of Endocrinology, Jagiellonian University in Krakow. The diagnosis of PSL were categorized as confirmed, probable, or undetermined in 26, 26 and 8 patients, accordingly. Given the possible aetiology congenital, inflammatory, and neoplastic stalk lesions were diagnosed in 17, 15 and 20 patients, accordingly. In eight cases the underlying pathology remained undetermined. The most common pituitary abnormality was gonadal insufficiency diagnosed in 50.8% of cases. Diabetes insipidus was detected in 23.3% of cases. In 5% of patients the pituitary function recovered partially over time. Stalk lesions were extensively discussed in the context of the current literature. Based on the published data and our own experience a diagnostic algorithm has been proposed to help physicians with the management of patients with this challenging condition.
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15
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Iglesias P, Guerrero-Pérez F, Villabona C, Díez JJ. Adenohypophyseal hyperfunction syndromes and posterior pituitary tumors: prevalence, clinical characteristics, and pathophysiological mechanisms. Endocrine 2020; 70:15-23. [PMID: 32613546 DOI: 10.1007/s12020-020-02399-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/20/2020] [Indexed: 11/26/2022]
Abstract
Posterior pituitary tumors are rare nonneuroendocrine neoplasms originating in the neurohypophysis that lack hormonal secretory capacity. Surprisingly, these tumors are relatively frequently associated with adenohypophyseal syndromes of hormonal hypersecretion such as Cushing's disease and acromegaly. Fifteen cases of posterior pituitary tumor associated with hypercortisolism have been reported to date, 13 of them were pituicytomas (Pi) and 2 were granular cell tumors (GCT). Six patients with posterior pituitary tumor associated with acromegaly have been reported (4 Pi and 2 GCT). The main forms of clinical presentation and the possible pathophysiological mechanisms of this association are reviewed.
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Affiliation(s)
- Pedro Iglesias
- Departments of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
- Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain.
| | | | - Carles Villabona
- Hospital Universitario Bellvitge l'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan José Díez
- Departments of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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16
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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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17
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Borg A, Jaunmuktane Z, Dorward N. Tumors of the Neurohypophysis: One Unit's Experience and Literature Review. World Neurosurg 2020; 134:e968-e978. [DOI: 10.1016/j.wneu.2019.11.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 11/28/2022]
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18
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Marco Del Pont F, Villalonga JF, Ries-Centeno T, Arakaki N, Katz D, Cervio A. Pituicytoma Associated with Acromegaly and Cushing Disease. World Neurosurg 2019; 136:78-82. [PMID: 31874293 DOI: 10.1016/j.wneu.2019.12.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pituicytoma is a rare neoplasm arising in the sellar region (World Health Organization grade I). Clinically, pituicytomas mimic nonfunctioning pituitary macroadenomas and are occasionally incidentally discovered at autopsy. Pituitary adenomas can occur with other sellar pathologies, and the term "collision sellar lesions" has been coined for this rare entity. There have only been a few reports of the coexistence of pituicytoma and pituitary adenoma. We present 2 cases of pituicytoma coexisting with acromegaly and Cushing disease. CASE DESCRIPTION Case 1: A 29-year-old woman had acromegaly. The macroadenoma was partially removed in her first surgery; thus an endonasal reoperation was required for debulking and posterior radiosurgery. Pituicytoma coexisting with somatotropinoma was diagnosed on pathologic examination. Case 2: A 33-year-old woman had adrenocorticotropic hormone-dependent Cushing disease. She underwent endonasal resection. Undetectable postoperative cortisol levels provided evidence that the underlying adrenocorticotropic hormone source was successfully removed. On the basis of morphologic features and the immunohistochemical profile, pituicytoma was diagnosed on pathologic examination. Pituitary adenoma was not confirmed histologically in this patient. CONCLUSIONS Only 117 cases of pituicytoma have been reported since it was first described in 1955. Before our report, only 5 cases of patients with pituicytoma coexisting with pituitary adenoma had been described. The coexistence of these 2 entities may not just be a mere coincidence but may be due to a yet unknown pathophysiologic link or common progenitor lineage of both lesions. Association between pituicytoma and pituitary adenoma is increasingly being reported.
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Affiliation(s)
| | - Juan F Villalonga
- LINT, Faculty of Medicine, National University of Tucumán, Tucumán, Argentina
| | | | - Naomi Arakaki
- Department of Anatomy and Pathology, FLENI, Buenos Aires, Argentina
| | - Debora Katz
- Department of Endocrinology, FLENI, Buenos Aires, Argentina
| | - Andrés Cervio
- Department of Neurosurgery, FLENI, Buenos Aires, Argentina
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19
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Lee SJ, Cohen J, Chan J, Walgama E, Wu A, Mamelak AN. Infectious Complications of Expanded Endoscopic Transsphenoidal Surgery: A Retrospective Cohort Analysis of 100 Cases. J Neurol Surg B Skull Base 2019; 81:497-504. [PMID: 33134016 DOI: 10.1055/s-0039-1696999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/08/2019] [Indexed: 12/14/2022] Open
Abstract
Objective To identify perioperative factors that may predict postoperative cerebrospinal fluid (CSF) leak and meningitis following expanded endoscopic transsphenoidal surgery (EETS). Study Design This is a retrospective study. This study was set at the Cedars-Sinai Medical Center, Los Angeles. A total of 78 patients who underwent EETS between January 2007 and November 2018 were participated. The main outcome measures were CSF leak and meningitis. Results A total of 78 patients underwent a total of 100 EETS procedures; 17.9 and 10.3% of patients developed postoperative CSF leaks and meningitis, respectively. Out of eight, three patients with meningitis did not develop an observable CSF leak. The risk of developing meningitis in patients with a CSF leak was significantly higher than those without a leak, with an odds ratio (OR) of 11.48 (95% confidence interval, 2.33-56.47; p = 0.004). Pituicytomas were significantly associated with meningitis compared with other pathologies. No other patient-specific factors were identified as risks for leak or meningitis, including method of skull base repair, sex, tumor volume, or body mass index, although there was a strong trend toward reduced CSF leak rates in patient with nasoseptal flaps used for skull base repair, compared with those without (9.5 vs. 25%). CSF protein was consistently elevated on the first CSF values obtained when meningitis was suspected. Conclusion CSF leak and meningitis are common complications of expanded endonasal surgery No statistically significant risk factors for developing a postoperative leak other than the pathology of pituicytoma were identified, including method of skull base repair, although the use of a vascularized nasoseptal flap did trend toward a reduced CSF leak rate. CSF protein is the most sensitive marker for the presumptive diagnosis and timely treatment of meningitis.
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Affiliation(s)
- Seung J Lee
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Justin Cohen
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Julie Chan
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Evan Walgama
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Arthur Wu
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
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20
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Guerrero-Pérez F, Marengo AP, Vidal N, Iglesias P, Villabona C. Primary tumors of the posterior pituitary: A systematic review. Rev Endocr Metab Disord 2019; 20:219-238. [PMID: 30864049 DOI: 10.1007/s11154-019-09484-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In 2017, the World Health Organization established that pituicytoma, granular cell tumor (GCT), spindle cell oncocytoma (SCO) and sellar ependymomas (SE) are posterior pituitary tumors (PPT). They probably arise from the pituicytes and may constitute a unique histopathological entity. We carried out a systematic review using PubMed's database. A total of 266 patients with pathological diagnosis of PPT (135 pituicytomas, 69 GCT, 47 SCO, 8 SE and 7 mixed histology tumors) were analyzed. Gender distribution was identical and median age at diagnosis was 48 ± 21.8 years. Main presentation symptoms were visual disorders (n = 142; 58.1%), headache (n = 99; 40.5%), hypopituitarism (n = 84; 34.4%), hypercortisolism (n = 10; 4.1%), polyuriapolydipsia (n = 6; 2.4%) and acromegaly features (n = 5; 2.0%). On MRI, 122 (47.6%) patients showed sellar with suprasellar extension masses, 67 (23.1%) were suprasellar and 63 (24.6%) exclusively sellar. Median tumor size was 22.0 ± 14.2 mm. Two hundred sixty four patients underwent surgery, transphenoidal access was selected in 132 (64.4%) and craniotomy in 58 (28.3%). Complications were hypopituitarism (n = 70; 42.1%), diabetes insipidus (n = 55; 33.1%) and hemorrhage (n = 50; 30.1%). Tumor persisted in 93 patients (45.6%) and recurred in 13 (6.4%). Regarding comparison between main types of PPT, SCO patients were diagnosed later (60.0 vs 47.0 vs 47.0 years, p = 0.023), the tumor was larger 25.0 mm [10.8] vs 20.0 mm [14.2] vs 2.0 mm [15.0] and they were frequently sellar with suprasellar extension tumors (71.7% vs 46.2% vs 32.8%, p = 0.003) compared to pituicytoma and GCT. In conclusion, PPT are rare tumors and have been misdiagnosed mainly as non-functioning pituitary adenomas. Different types of PPT share similar epidemiology, clinical manifestations and surgical outcomes. Surgery is the only curative option but complications and subtotal resection are common.
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Affiliation(s)
- Fernando Guerrero-Pérez
- Department of Endocrinology, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Agustina Pia Marengo
- Department of Endocrinology, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Noemi Vidal
- Department of Pathology, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Iglesias
- Department of Endocrinology, Puerta de Hierro Majadahonda University Hospital, Calle Manuel de Falla, 1, 28222, Majadahonda, Madrid, Spain
| | - Carles Villabona
- Department of Endocrinology, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
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21
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Carrasco-Moro R, Salge-Arrieta FJ, Pascual JM. Topographical factors guiding the surgical treatment of pituicytomas. Endocrine 2019; 64:200-201. [PMID: 30838515 DOI: 10.1007/s12020-019-01864-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
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22
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Roncaroli F, Villa C, Chatterjee D, Mansour M, Faustini-Fustini M, Giannini C, Gnanalingham K. Rare primary non-neuroendocrine tumours of the sella. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.mpdhp.2018.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Doknic M, Miljic D, Pekic S, Stojanovic M, Savic D, Manojlovic-Gacic E, Milenkovic T, Zdravkovic V, Jesic M, Damjanovic D, Lavrnic S, Soldatovic I, Djukic A, Petakov M. Single center study of 53 consecutive patients with pituitary stalk lesions. Pituitary 2018; 21:605-614. [PMID: 30276501 DOI: 10.1007/s11102-018-0914-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The etiological spectrum of pituitary stalk lesions (PSL) is wide and yet specific compared to the other diseases of the sellar and suprasellar region. Because of the pituitary stalk's (PS) critical location and role, biopsies of these lesions are rarely performed, and their underlying pathology is often a conundrum for clinicians. A pituitary MRI in association with a clinical context can facilitate their diagnosis. AIM To present the various causes of PSL-their clinical, hormonal, histopathological, and MRI characteristics in order to gain better insight into this pathology. METHOD A retrospective observational study consisting of 53 consecutive patients with PSL of the mean age 32 ± 4.2 years (range 6-67), conducted at the Department for Neuroendocrinology, Clinical Center of Serbia 2010-2018. RESULTS Congenital malformations were the most common cause of PSL in 25 of 53 patients (47.1%), followed by inflammatory (9/53; 16.9%) and neoplastic lesions (9/53; 16.9%). The exact cause of PSL was established in 31 (58.4%) patients, of whom 23 were with congenital PS abnormalities and 8 with histopathology of PSL (7 neoplastic and 1 Langerhans Cell Hystiocytosis). A probable diagnosis of PSL was stated in 12 patients (22.6%): 6 with lymphocytic panhypophysitis, while Rathke cleft cyst, tuberculosis, dissemination of malignancy in PS were each diagnosed in 2 patients. In 10 patients (18.8%), the etiology of PSL remained unknown. CONCLUSION Due to the inability of establishing an exact diagnosis, the management and prognosis of PSL are difficult in many patients. By presenting a wide array of causes implicated in this condition, we believe that our study can aid clinicians in the challenging cases of this pathology.
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Affiliation(s)
- Mirjana Doknic
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, Belgrade, 11000, Serbia.
- School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Dragana Miljic
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, Belgrade, 11000, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sandra Pekic
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, Belgrade, 11000, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Stojanovic
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, Belgrade, 11000, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Savic
- Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Emilija Manojlovic-Gacic
- Institute of Pathology, School of Medicine, University of Belgrade, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Milenkovic
- Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Belgrade, Serbia
| | - Vera Zdravkovic
- University Children's Clinic, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Maja Jesic
- University Children's Clinic, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dusan Damjanovic
- Center for Radiology Imaging - Magnetic Resonance and Gamma Knife, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slobodan Lavrnic
- Center for Radiology Imaging - Magnetic Resonance and Gamma Knife, Clinical Center of Serbia, Belgrade, Serbia
| | - Ivan Soldatovic
- Institute of Medical Statistics and Informatics, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Djukic
- Center for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Kragujevac, Kragujevac, Serbia
| | - Milan Petakov
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, Belgrade, 11000, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
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