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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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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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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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Salge-Arrieta FJ, Carrasco-Moro R, Rodríguez-Berrocal V, Pian H, Martínez-San Millán JS, Iglesias P, Ley-Urzáiz L. Clinical features, diagnosis and therapy of pituicytoma: an update. J Endocrinol Invest 2019; 42:371-384. [PMID: 30030746 DOI: 10.1007/s40618-018-0923-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pituicytomas (PTs) are extremely rare, low-grade glial tumors closely related to the neurohypophyseal axis. Definite conclusions concerning the optimal diagnostic and therapeutic approach to these neoplasms are lacking to date, as most of this information has been presented as case reports. METHODS Retrospective review of case reports published in the scientific literature to date, including a new illustrative example treated in our department. RESULTS 116 cases were collected. PTs had a higher prevalence in the fifth and sixth decades of life, with a slight male predominance. Main symptoms, which tended to be progressive, included visual field defects and pituitary-hypothalamic dysfunction. Radiologically, PTs were found anywhere along the hypothalamic-pituitary axis mimicking other, more frequent tumors growing in this anatomical region. Surgical treatment included both transcranial or transsphenoidal approaches, and resulted in gross total resection and morbidity rates of 46.8 and 59%, respectively; the latter essentially consisted in anterior and posterior pituitary dysfunction, with limited impact on daily quality of life. CONCLUSIONS Due to both low frequency and the absence of pathognomonic clinical and/or radiological features, formulating a suspicion diagnosis of PT represents a considerable challenge even for experienced professionals. The indication for treatment should be made on an individual basis, but it is inescapable in the presence of a visual field defect. The surgical approach has to be tailored according to the topography of the tumor and preoperative symptoms; the greatest challenges in accomplishing a gross total removal are represented by the degree of adherence and vascularization of the PT.
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Affiliation(s)
- F J Salge-Arrieta
- Department of Neurosurgery, Ramón y Cajal University Hospital, Madrid, Spain.
| | - R Carrasco-Moro
- Department of Neurosurgery, Ramón y Cajal University Hospital, Madrid, Spain
| | | | - H Pian
- Department of Neuropathology, Ramón y Cajal University Hospital, Madrid, Spain
| | | | - P Iglesias
- Department of Endocrinology, Ramón y Cajal University Hospital, Madrid, Spain
| | - L Ley-Urzáiz
- Department of Neurosurgery, Ramón y Cajal University Hospital, Madrid, Spain
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Guerrero-Pérez F, Vidal N, Marengo AP, Pozo CD, Blanco C, Rivero-Celada D, Díez JJ, Iglesias P, Picó A, Villabona C. Posterior pituitary tumours: the spectrum of a unique entity. A clinical and histological study of a large case series. Endocrine 2019; 63:36-43. [PMID: 30276594 DOI: 10.1007/s12020-018-1774-2] [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] [Received: 07/23/2018] [Accepted: 09/24/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE In 2017, the WHO established that pituicytoma, granular cell tumour (GCT) and spindle cell oncocytoma (SCO) are posterior pituitary tumours (PPT). Recent data suggests that these tumours probably arise from the pituicytes and may constitute a spectrum of a unique histopathological entity. Our aim is to report the clinical findings and surgical outcomes of 16 patients with PPT. We also evaluated the tissue specimens available in light of current knowledge. METHOD Cross-sectional study with retrospective data. RESULTS PPT were 7 pituicytomas, 3 GCT and 6 SCO. Patients mean age was 55 years old and 75% were female. Basal hormonal study showed hyperprolactinemia (43.7%) and hypopituitarism (37.5%). There was no case of diabetes insipidus (DI). MRI showed sellar/suprasellar masses with mean size of 19.7mm. PPT was not suspected in any patient. Fifteen patients underwent surgery and complications were common: 20% had perioperative bleeding (one patient died because of a massive haemorrhage), 57.1% hypopituitarism, 35.7% permanent DI and 21.4% underwent a second surgery. Pathological findings shown positivity for thyroid transcription factor 1, vimentin and negativity for cytokeratin and chromogranin A in all specimens evaluated. S100 protein was positive in 88.8% of tumours. Ki67 was ≥ 3% in 66.6% and ranged from 4-7% in SCO. CONCLUSION PPT have similar histology, clinical features and are frequently misdiagnosed as nonfunctioning pituitary tumours. However, post-surgical complications including haemorrhage are common. A high clinical suspicion is needed to presume the diagnosis prior surgery and diminish the high morbidity of these tumours.
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Affiliation(s)
| | - Noemi Vidal
- Department of Pathology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Agustina Pia Marengo
- Department of Endocrinology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Carlos Del Pozo
- Department of Endocrinology, Hospital Universitari Mutua Terrassa, Barcelona, Spain
| | - Concepción Blanco
- Department of Endocrinology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - David Rivero-Celada
- Department of Neurosurgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Juan José Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Antonio Picó
- Department of Endocrinology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Carles Villabona
- Department of Endocrinology, Hospital Universitari de Bellvitge, Barcelona, Spain
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Zygourakis CC, Rolston JD, Lee HS, Partow C, Kunwar S, Aghi MK. Pituicytomas and spindle cell oncocytomas: modern case series from the University of California, San Francisco. Pituitary 2015; 18:150-8. [PMID: 24823438 DOI: 10.1007/s11102-014-0568-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Pituicytomas and spindle cell oncocytomas (SCOs) are extremely rare neoplasms of the sellar and suprasellar region that can often mimic pituitary adenomas. To date, there are relatively few cases of pituicytomas and SCOs reported; and most of these are small case series. METHODS In this paper, we provide a retrospective review of the treatment, imaging characteristics, post-operative course, and histopathology of five cases of pituicytomas and two SCOs treated at the University of California, San Francisco (UCSF) over a 10-year period from 2003 to 2013. RESULTS We find that pituicytomas and SCOs present similarly to pituitary adenomas, and look identical on CT or MR imaging. We histopathologically confirmed all pituicytomas with a combination of hematoxylin and eosin morphology and immunohistochemical positivity for vimentin and S100; SCOs stain for anti-mitochondrial antigen and endothelial membrane antigen. We observe positive thyroid transcription factor 1 (TTF1) immunohistochemistry in both cases of SCO, as well as in both of the cases of pituicytoma in which TTF1 staining was available. CONCLUSIONS This represents the largest single-institution case series of pituicytomas and SCOs to date, and also includes the first description of the management of a pregnant female with SCO. Our findings are consistent with the idea of common histogenesis for pituicytomas and SCOs, and also raise the possibility of more aggressive growth in SCOs as compared to pituicytomas.
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Affiliation(s)
- Corinna C Zygourakis
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, Rm 779M, San Francisco, CA, 94143-0112, USA
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Feng M, Carmichael JD, Bonert V, Bannykh S, Mamelak AN. Surgical management of pituicytomas: case series and comprehensive literature review. Pituitary 2014; 17:399-413. [PMID: 24037647 DOI: 10.1007/s11102-013-0515-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Pituicytomas are rare neoplasms that typically present as solid, noninfiltrative tumors occupying the sella and/or suprasellar space for which there is no consensus on optimal surgical management. We aimed to define a preferred surgical strategy for these tumors based on our clinical experience and comprehensive review of the world literature. DESIGN Case series and review of the literature. METHODS We documented the clinical, radiographic, and surgical findings of three patients with pituicytoma treated at our institution, as well as complications and long-term outcomes. A comprehensive review of the medical literature identified all cases of pituicytoma for which data regarding surgical approach, outcome and complications could be extracted. We compared our results with published data. RESULTS All three cases at our institution achieved gross total removal. Two patients underwent an expanded endoscopic endonasal transsphenoidal and transplanum (EETS-TP) approach, while one tumor was removed via craniotomy. Post-operatively all patients developed pan-hypopitutarism. The patient undergoing craniotomy suffered profound visual loss but no other neurological complications were noted. A literature review identified 67 reported cases of pituicytoma. Surgical data was available in 60 cases. Surgical approach was documented in 57 patients. Sixty-three surgeries were performed in which approach and extent of resection was available. Gross total removal was obtained in 33 % of craniotomies, 42 % of transsphenoidal procedures, and 100 % of expanded transsphenoidal procedures. Neurological complications including visual loss, hemiparesis and cranial nerve palsies were reported after craniotomy, but not after transsphenoidal approaches. Overall EETS-TP approaches were associated with the highest rate of gross total removal and no visual or neurological complications. CONCLUSIONS EETS-TP surgery is the preferred strategy for surgical removal of pituicytoma. EETS-TP and transsphenoidal approaches are associated with higher rates of gross total removal and lower rates of neurological complications than craniotomy. Gross total removal should be the intended goal of surgery.
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Affiliation(s)
- Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
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Tian Y, Yue S, Jia G, Zhang Y. Childhood giant pituicytoma: A report and review of the literature. Clin Neurol Neurosurg 2013; 115:1943-50. [DOI: 10.1016/j.clineuro.2013.07.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 06/30/2013] [Accepted: 07/28/2013] [Indexed: 10/26/2022]
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