1
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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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2
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Goodman AL, Velázquez Vega JE, Rey Martinez LC, Brat DJ, Schniederjan MJ. Epithelioid Pituicytoma: Expanding the Morphologic Spectrum of a Rare Neoplasm. J Neuropathol Exp Neurol 2021; 79:1376-1378. [PMID: 32935128 DOI: 10.1093/jnen/nlaa076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/15/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Abigail L Goodman
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - José E Velázquez Vega
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Pathology and Laboratory Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - Daniel J Brat
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Matthew J Schniederjan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Pathology and Laboratory Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
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3
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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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4
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Viaene AN, Lee EB, Nasrallah MP. Intraoperative cytology of pituicytomas. Diagn Cytopathol 2019; 48:342-349. [PMID: 31883319 DOI: 10.1002/dc.24372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pituicytoma is a rare tumor of the sella and suprasellar region. It is common for these tumors to be misdiagnosed radiographically as pituitary adenomas, meningiomas, and craniopharyngiomas. Histologically, pituicytomas are also known to show variable morphology. These factors often complicate intraoperative consultation, especially when tissue is limited. METHODS A database search (January 1990-June 2019) identified 13 surgically resected pituicytomas that were sent for intraoperative consultation. The intraoperative cytology was reviewed by two pathologists, and both squash preparations/smears and touch preparations were included. RESULTS The cytological features of pituicytomas were variable. The cytoplasm ranged from fibrillary to fine and wispy. The nuclei were round to ovoid with occasional tumors showing spindled morphology. Small nucleoli were seen in all tumors, and chromatin was fine to vesicular. While squash preparations were cellular and revealed cohesive groups of tumor cells, touch preparations were often paucicellular with the exception of one tumor. The cytological features of pituicytomas are compared to those of other tumors with similar radiographic appearances. CONCLUSIONS Our findings illustrate the range of cytological features of these rare tumors and highlight the difficulty in making a definitive intraoperative diagnosis. Pituicytomas should be considered in the differential of a sellar/suprasellar lesion with glial and meningioma-like cytological features.
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Affiliation(s)
- Angela N Viaene
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - MacLean P Nasrallah
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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5
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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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6
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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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7
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Vellutini EDAS, Becker PHP, Godoy LF, Guerreiro NFC, Mattedi RL, de de Oliveira MF. Epithelioid pituicytoma: An unusual case report. Surg Neurol Int 2018; 9:145. [PMID: 30105139 PMCID: PMC6069369 DOI: 10.4103/sni.sni_319_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 06/14/2018] [Indexed: 11/08/2022] Open
Abstract
Background: Pituicytomas are considered World Health Organization Grade I malignancies. Until September 2017, a total of 81 cases of pituicytomas were diagnosed and described in literature. We present such a case in which histopathology shows an epithelioid pattern, a rare variant of pituicytoma. As far as we know, this is only the second such case described in the literature. Case Description: A 61-year-old male patient presented with complaints of progressive decrease in visual acuity for about 7 months, worse on the left side. Laboratory and endocrinological investigation returned normal values. Magnetic resonance imaging revealed a mixed solid-cystic lesion, measuring about 3.1 × 2.2 × 2.9 cm. The lesion presented with intermediate signal intensity in T1 and T2 sequences and showed avid postcontrast enhancement. The patient underwent resection through a left pterional approach. Pathology revealed a glial neoplasm with an epithelioid pattern and moderate cellularity with rounded-elongated cell nuclei and with a broad eosinophilic cytoplasm. Absence of cellular pleomorphism, any mitotic figures, or areas of necrosis was noted. Conclusion: The epithelioid variant of pituicytomas differs from the commonly encountered forms of this tumor which typically present in a fascicular pattern. Microsurgical resection is the treatment of choice. However, in many cases, subtotal resection was performed because of a considerable risk for neurovascular injuries.
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Affiliation(s)
- Eduardo de Arnaldo Silva Vellutini
- Neurosurgery Department, DFV Neuro, São Paulo, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil.,Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Pedro Henrique Petit Becker
- Neurosurgery Department, DFV Neuro, São Paulo, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil.,Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | | | - Matheus Fernandes de de Oliveira
- Neurosurgery Department, DFV Neuro, São Paulo, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil.,Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
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8
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Peron S, Mandelli J, Galante N, Colombo S, Locatelli D. Recurrent Pituicytoma with Pseudoaneurysm: Report of a Challenging Case. World Neurosurg 2017; 105:1043.e1-1043.e5. [PMID: 28705702 DOI: 10.1016/j.wneu.2017.06.171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/28/2017] [Accepted: 06/30/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pituicytoma is a rare tumor originating from glial cells of the adult neurohypophysis and infundibulum. Surgical removal is the treatment of choice for this neoplasm. In recent years the endoscopic endonasal approach has proven to be a viable and effective alternative to standard craniotomy. CASE DESCRIPTION We report a case of a patient submitted to surgical treatment for a recurrence of pituicytoma, which was operated on transcranially at another hospital approximately 5 years previously. After transcranial surgery, the patient developed a symptomatic recurrence and an undisclosed intrasellar pseudoaneurysm that were treated with an endoscopic endonasal approach, but still required an intracranial approach to complete the resection. CONCLUSIONS An intrasellar pseudoaneurysm can endanger the endoscopic removal of the pituicytoma, forcing the surgeon to reevaluate a microscopic transcranial approach or to consider a staged procedure.
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Affiliation(s)
- Stefano Peron
- Department of Neurosurgery, ASST West Milan - Legnano Hospital, Legnano, Italy.
| | - Jaime Mandelli
- Department of Neurosurgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Galante
- Department of Neurosurgery, ASST West Milan - Legnano Hospital, Legnano, Italy
| | - Stefano Colombo
- Department of Otolaryngology, ASST West Milan - Legnano Hospital, Legnano, Italy
| | - Davide Locatelli
- Department of Neurosurgery, University of Insubria, ASST Seven Lakes - Varese Hospital, Varese, Italy
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9
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Hagel C, Buslei R, Buchfelder M, Fahlbusch R, Bergmann M, Giese A, Flitsch J, Lüdecke DK, Glatzel M, Saeger W. Immunoprofiling of glial tumours of the neurohypophysis suggests a common pituicytic origin of neoplastic cells. Pituitary 2017; 20:211-217. [PMID: 27744503 DOI: 10.1007/s11102-016-0762-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyse the antigen expression profiles of 27 cases of pituicytoma, spindle cell oncocytoma, and granular cell tumour of the sellar region concerning a common pituicytic origin of neoplastic cells. METHODS Material from 12 female and 15 male patients (13 granular cell tumours of the sellar region, 10 pituicytomas, four spindle cell oncocytomas) collected in the German Registry of Pituitary Tumours between 1993 and 2015 was re-evaluated according to the current WHO classification of tumours of the central nervous system and supplementary immunohistochemistry including S100-protein, CD56, CD68, thyroid transcription factor-1 (TTF-1), and Ki-67 was performed. RESULTS S100-protein was detected in all 27 tumours and TTF-1 in all 16 tumours that were assessed. Vimentin was expressed in all 13 cases investigated whereas broad spectrum cytokeratin was not detected in any of 14 evaluated cases. GFAP was observed in nine out of 21 cases. 15 out of 17 investigated lesions showed some CD68 expression and five out of 14 cases were labelled with CD56 antibodies. Proliferative activity did not differ significantly between the three tumour subgroups although one primary and one recurrent pituicytoma showed exceptionally high Ki-67-proliferation indices of 15.3 and 12.7 %, respectively (means: granular cell tumour of the sellar region 2.0 %, pituicytoma 2.8 %, spindle cell oncocytoma 2.7 %). CONCLUSIONS The study confirms and expands earlier data and is in line with the notion that the three tumour types are variants of pituicytoma.
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Affiliation(s)
- Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Rolf Buslei
- Department of Neuropathology, Friedrich-Alexander University Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Michael Buchfelder
- Neurochirurgische Klinik, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Rudolf Fahlbusch
- International Neuroscience Institute (INI), Rudolf-Pichelmayr-Str. 4, 30625, Hannover, Germany
| | - Markus Bergmann
- Klinikum Bremen-Mitte, Zentrum für Pathologie, Institut für klinische Neuropathologie, St.-Jürgen-Str. 1, 28177, Bremen, Germany
| | - Armin Giese
- Zentrum für Neuropathologie und Prionforschung, Ludwig-Maximilians-Universität München, Feodor-Lynen-Str. 23, 81377, Munich, Germany
| | - Jörg Flitsch
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Dieter K Lüdecke
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Wolfgang Saeger
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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10
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Wang J, Liu Z, Du J, Cui Y, Fang J, Xu L, Li G. The clinicopathological features of pituicytoma and the differential diagnosis of sellar glioma. Neuropathology 2016; 36:432-440. [PMID: 26919073 DOI: 10.1111/neup.12291] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/17/2016] [Accepted: 01/18/2016] [Indexed: 11/28/2022]
Abstract
Pituicytoma is rare and difficult to diagnose. This study explored the clinicopathological features, immunophenotype and differential diagnosis of pituicytoma. We compared 11 cases of pituicytoma and 26 cases of sellar glioma (16 pilocytic astrocytomas, four diffuse astrocytomas, three pilomyxoid astrocytomas, and three third ventricle chordoid gliomas). The 11 pituicytoma cases involved six men and five women (age: 33-65 years). Three of the 11 patients experienced recurrence due to a residual tumor, and one patient underwent three surgeries during a 6-month period. Imaging findings revealed tumors were in the intrasellar region (four cases), suprasellar region (four cases) and intra-suprasellar regions (three cases). The tumor diameters were 1.3-3.8 cm, and the preoperative diagnoses were pituitary adenoma, craniopharyngioma and meningioma. The tumors were solid and contained spindle or slightly chubby cells that were densely arranged with visible cleft-like or expanded sinusoid structures. The cells had vague boundaries, circular nuclei, fine chromatin, and a small nucleolus. Immunohistochemical staining of the pituicytomas revealed positive expression of thyroid transcription factor-1 (TTF-1) and S-100 protein (S-100), positive focal expression of glial GFAP;(five of 11 cases), and negative oligodendrocyte transcription factor 2 (Olig2), CD34 and neurofilament expression. The Ki67 index was 6% in one case and 1-2% in the other cases. Unlike pituicytoma, most sellar glioma cases exhibited GFAP and Olig2 expression, and negative TTF-1 expression. Third ventricle chordoid gliomas expressed TTF-1, GFAP and CD34, and were negative for Olig2. Our results indicate that pituicytoma typically involves dense arrangements of spindle or slightly chubby cells. The morphology is occasionally atypical, with ependymoma-like or meningioma-like structures, and occasionally exhibits pilomyxoid degeneration. Abundant sinusoids are characteristic of hemorrhagic tumors. The dense spindle cell arrangement is a relatively specific morphology, and staining for GFAP, TTF-1, Olig2 and CD4 may help differentiate pituicytoma from sellar glioma.
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Affiliation(s)
- Junmei Wang
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, China National Clinical Research Center for Neurological Diseases, NCRC-ND, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing, China
| | - Zhaoxia Liu
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, China National Clinical Research Center for Neurological Diseases, NCRC-ND, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing, China
| | - Jiang Du
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, China National Clinical Research Center for Neurological Diseases, NCRC-ND, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing, China
| | - Yun Cui
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, China National Clinical Research Center for Neurological Diseases, NCRC-ND, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing, China
| | - Jingyi Fang
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, China National Clinical Research Center for Neurological Diseases, NCRC-ND, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing, China
| | - Li Xu
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, China National Clinical Research Center for Neurological Diseases, NCRC-ND, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing, China
| | - Guilin Li
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, China National Clinical Research Center for Neurological Diseases, NCRC-ND, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing, China
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11
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Xie-Jun Z, Guo-Dong H, Tao J, Zhang XB, Wen-Lan L, Wei-Ping L. A 30-Year-Old Female with a Suprasellar Tumor. Brain Pathol 2015; 26:128-9. [PMID: 26576039 DOI: 10.1111/bpa.12338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Zhang Xie-Jun
- Department of Neurosurgery, The first affiliate hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Huang Guo-Dong
- Department of Neurosurgery, The first affiliate hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Ji Tao
- Department of Neurosurgery, The first affiliate hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Xiao-Biao Zhang
- Department of Neurosurgery, Zhongshan Hospital Fu Dan University, Shanghai, China
| | - Liu Wen-Lan
- Central Laboratory of Shenzhen Second People's Hospital, The first affiliate hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Li Wei-Ping
- Department of Neurosurgery, The first affiliate hospital of Shenzhen University, Shenzhen, Guangdong, China
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12
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Suprasellar chordoid neoplasm with expression of thyroid transcription factor 1: evidence that chordoid glioma of the third ventricle and pituicytoma may form part of a spectrum of lineage-related tumors of the basal forebrain. Hum Pathol 2015; 46:1045-9. [PMID: 25934249 DOI: 10.1016/j.humpath.2015.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/05/2015] [Accepted: 03/09/2015] [Indexed: 11/20/2022]
Abstract
Chordoid glioma of the third ventricle is a rare neuroepithelial tumor characterized by a unique histomorphology and exclusive association with the suprasellar/third ventricular compartment. Variously interpreted as either astrocytic- or ependymal-like, and speculatively ascribed to the lamina terminalis/subcommissural organ, its histogenesis remains, nevertheless, unsettled. Here, we report on a suprasellar chordoid glioma occurring in a 52-year-old man. Although displaying otherwise typical morphological features, the tumor was notable for expression of thyroid transcription factor 1, a marker of tumors of pituicytic origin in the context of the sellar region. We furthermore found overlapping immunoprofiles of this example of chordoid glioma and pituicytic tumors (pituicytoma and spindle cell oncocytoma), respectively. Specifically, phosphorylated ribosomal protein S6, a marker of mTOR pathway activation, was expressed in both groups. Based on these findings, we suggest that chordoid glioma and pituicytic tumors may form part of a spectrum of lineage-related neoplasms of the basal forebrain.
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13
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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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Kleinschmidt-DeMasters BK, Lopes MBS. Update on hypophysitis and TTF-1 expressing sellar region masses. Brain Pathol 2013; 23:495-514. [PMID: 23701182 DOI: 10.1111/bpa.12068] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 05/13/2013] [Indexed: 01/23/2023] Open
Abstract
This article reviews recent literature on sellar region masses that most closely mimic nonsecretory pituitary adenomas: hypophysitis, pituicytoma, spindle cell oncocytoma, and granular cell tumor of neurohypophysis. Even today, these four entities often cannot be confidently distinguished from each other clinically or by preoperative neuroimaging features. Thus, they often come to biopsy/surgical resection and require tissue confirmation of diagnosis. Causes of secondary and primary hypophysitis will be discussed, including two newly described types, IgG4 plasma cell hypophysitis and hypophysitis caused by anti-cytotoxic T-lymphocyte antigen 4 antibody therapy for cancer. For the neoplastic conditions, emphasis will be placed on literature that has emerged since these entities were first codified in the 2007 World Health Organization fascicle. The finding that immunohistochemical staining for thyroid transcription factor-1 is shared by pituicytoma, spindle cell oncocytoma, and granular cell tumor of neurohypophysis suggests common lineage and explains why histological overlap can be encountered. We incorporate our own experiences over the last 30 years from two referral institutions with specialty practices in pituitary region masses.
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Rivero-Celada D, Barrera-Rojas M, Orduna-Martínez J, Lorente-Muñoz A, Alfaro-Torres J, Alberdi-Viñas J. [Pituitary pituicytoma]. Neurocirugia (Astur) 2012; 23:165-9. [PMID: 22796297 DOI: 10.1016/j.neucir.2012.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 03/22/2012] [Accepted: 03/25/2012] [Indexed: 10/28/2022]
Abstract
Pituicytomas are rare entities which develop in the neurohypophysis. They were included in the last World Health Organization (WHO) Classification of Central Nervous System Tumours in 2007, but for many years they have been confused with other pituitary tumours. We report the case of a 31-year-old woman who was diagnosed of a tumour in the suprasellar region during an infertility study due to hypogonadotropic hypogonadism and slight hyperprolactinemia. A standard pterional approach was performed, achieving total tumour excision. After the surgery the patient suffered bitemporal hemianopsia, diabetes insipidus and panhypopituitarism, although she recovered from the latter 2 in a few weeks. We conducted a review of the most common clinical and radiological features of this entity, as well as the treatments proposed in the literature to treat this rare tumour.
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Affiliation(s)
- David Rivero-Celada
- Servicio de Neurocirugía, Hospital Universitario Miguel Servet, Zaragoza, España
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