1
|
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.
Collapse
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
| |
Collapse
|
2
|
Das L, Vaiphei K, Rai A, Ahuja CK, Singh P, Mohapatra I, Chhabra R, Bhansali A, Radotra BD, Grossman AB, Korbonits M, Dutta P. Posterior pituitary tumours: patient outcomes and determinants of disease recurrence or persistence. Endocr Connect 2021; 10:387-400. [PMID: 33709954 PMCID: PMC8142326 DOI: 10.1530/ec-20-0621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/11/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Posterior pituitary tumours (PPTs) are rare neoplasms with the four recognised subtypes unified by thyroid transcription factor -1 (TTF-1) expression, according to the 2017 WHO classification. Though traditionally defined as low-grade neoplasms, a substantial proportion of them show recurrence/persistence following surgery. METHODS We selected patients with PPTs in our cohort of 1760 patients operated for pituitary tumours over the past 10 years (2010-2019). The clinical, radiological, hormonal, histopathological profiles and long-term outcomes of the three cases identified (two pituicytomas and one spindle cell oncocytoma, SCO) were analysed. Following a literature review, data of all published cases with documented TTF-1 positive pituicytomas and SCOs were analysed to determine the predictors of recurrence/persistence in these tumours. RESULTS Patients presented with compressive features or hypogonadism. Two had sellar-suprasellar masses. One had a purely suprasellar mass with a pre-operative radiological suspicion of pituicytoma. Two were operated by transsphenoidal surgery and one transcranially guided by neuronavigation. Histopathology confirmed spindle cells in a storiform arrangement and low Ki67 index. Immunohistochemistry showed positive TTF-1, S-100 expression and variable positivity for EMA, vimentin and GFAP. Re-evaluation showed recurrence/persistence in two patients. A literature review of recurrent/persistent pituicytoma (n = 17) and SCO (n = 9) cases revealed clinical clues (headache for pituicytomas, male gender for SCO), baseline tumour size (≥20.5 mm with sensitivity exceeding 80%) and longer follow-up duration as determinants of recurrence/persistence. CONCLUSION PPTs are rare sellar masses with quintessential TTF-1 positivity. Recurrent/persistent disease following surgery is determined by greater tumour size at baseline and duration of follow-up. This warrants intensive and long-term surveillance in these patients.
Collapse
Affiliation(s)
- Liza Das
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India
| | - Kim Vaiphei
- Department of Histopathology, PGIMER, Chandigarh, India
| | - Ashutosh Rai
- Department of Translational and Regenerative Medicine, PGIMER, Chandigarh, India
| | | | | | - Ishani Mohapatra
- Department of Pathology and Laboratory Medicine, Medanta, The Medicity, Gurgaon, India
| | | | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India
| | | | - Ashley B Grossman
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Green Templeton College, University of Oxford, Oxford, UK
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Pinaki Dutta
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India
- Correspondence should be addressed to P Dutta:
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
|
7
|
Chang TW, Lee CY, Jung SM, Lai HY, Chen CT, Yeap MC, Chuang CC, Hsu PW, Chang CN, Tu PH, Lee ST. Correlations between clinical hormone change and pathological features of pituicytoma. Br J Neurosurg 2018; 32:501-508. [PMID: 29749277 DOI: 10.1080/02688697.2018.1472212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Ting-Wei Chang
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Ching-Yi Lee
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Shih-Ming Jung
- Departments of Pathology, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Hung-Yi Lai
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Chun-Ting Chen
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Mun-Chun Yeap
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Chi-Cheng Chuang
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Peng-Wei Hsu
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Chen-Nen Chang
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Po-Hsun Tu
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Shih-Tseng Lee
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| |
Collapse
|
8
|
Yang X, Liu X, Li W, Chen D. Pituicytoma: A report of three cases and literature review. Oncol Lett 2016; 12:3417-3422. [PMID: 27900014 PMCID: PMC5103963 DOI: 10.3892/ol.2016.5119] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 06/27/2016] [Indexed: 11/10/2022] Open
Abstract
Pituicytoma is a rare tumor of the sellar and suprasellar regions, arising from the pituicytes, which are specialized glial cells in the neurohypophysis and infundibulum. Due to its rarity, ambiguity persists over the diagnosis, management and prognosis of pituicytoma. The current study presents a case series of three patients, each with a histopathological diagnosis of pituicytoma. A summary of the clinical manifestations, radiological characteristics, histopathological features, treatment strategies and prognoses are presented. In addition, 78 cases of pituicytoma, identified in a search of the published literature in Pubmed, are profiled. Pituicytoma typically presents with dysfunction of the optic nerve and pituitary. The radiological characteristics are nonspecific; diagnosis is typically made on the basis of histopathological results. The tumor is slow growing and benign and is amenable to surgical treatment by gross total resection; subsequent tumor recurrence is rare. A definitive assessment of prognosis requires an extended follow-up in a larger cohort.
Collapse
Affiliation(s)
- Xiaoyu Yang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiaoliang Liu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Wensen Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Dawei Chen
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
- Correspondence to: Dr Dawei Chen, Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Avenue, Changchun, Jilin 130021, P.R. China, E-mail:
| |
Collapse
|
9
|
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]
|
10
|
Pituicytoma: Report of three cases with review of literature. Pathol Res Pract 2013; 209:52-8. [DOI: 10.1016/j.prp.2012.10.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 10/02/2012] [Accepted: 10/12/2012] [Indexed: 11/19/2022]
|
11
|
Kosuge Y, Hiramoto J, Morishima H, Tanaka Y, Hashimoto T. Neuroimaging characteristics and growth pattern on magnetic resonance imaging in a 52-year-old man presenting with pituicytoma: a case report. J Med Case Rep 2012; 6:306. [PMID: 22989192 PMCID: PMC3537696 DOI: 10.1186/1752-1947-6-306] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 08/11/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED INTRODUCTION Pituicytoma is a rare neoplasm of the neurohypophysis. To the best of our knowledge there have been no reports of pituicytoma in which long-term magnetic resonance imaging observation was performed. We calculated the doubling time of the tumor volume and described the growth pattern of a pituicytoma. CASE PRESENTATION A 52-year-old Japanese man with a history of decreased libido was found to have a sellar and suprasellar mass. He underwent transsphenoidal surgery, but only a small specimen was obtained because of intraoperative bleeding. The tentative histological diagnosis was schwannoma. He noticed bitemporal hemianopsia 7 years later. A follow-up magnetic resonance imaging disclosed a tumor volume doubling time of 3830 days. Transcranial gross-total tumor resection was performed. The lesion consisted of elongated and plump tumor cells that were arranged in a fascicular or storiform pattern and were positive for S-100 protein and focally positive for glial fibrillary acidic protein. The final histological diagnosis was pituicytoma. CONCLUSION Pituicytoma is a slow-growing tumor, but the growth rate may change during follow-up.
Collapse
Affiliation(s)
- Yasushi Kosuge
- Department of Neurosurgery, St, Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | | | | | | | | |
Collapse
|
12
|
Abstract
The pituicytoma is an extremely rare and little-studied primary tumour of the adult neurohypophysis. With total resection, the pituicytoma appears to have a good prognosis. However, its highly vascular nature makes total resection difficult and local recurrence after subtotal resection is not uncommon. To date, only 40 cases of pituicytoma have been reported in literature. In addition to our own case of a suprasellar pituicytoma, we are reviewing and discussing these with particular attention paid on the surgical management and outcome of this rare neoplasm.
Collapse
|
13
|
Secci F, Merciadri P, Rossi DC, D'Andrea A, Zona G. Pituicytomas: radiological findings, clinical behavior and surgical management. Acta Neurochir (Wien) 2012; 154:649-57; discussion 657. [PMID: 22120541 DOI: 10.1007/s00701-011-1235-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Accepted: 11/10/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pituicytomas are rare low-grade glial neoplasms originating in the neurohypophysis or infundibulum that appear as solid, noninfiltrative masses occupying the sella turcica, the suprasellar space or both. Due to their high tendency to bleed and the possible firmness and adhesion to surrounding structures, preoperative diagnosis of pituicytoma is a goal for the surgeon, but it is actually a challenge because of the absence of distinctive clinical or neuroradiological findings. METHODS We report the new cases of three patients who underwent transsphenoidal surgery for suspected pituitary adenomas, which were determined to be pituicytomas at histological and immunohistochemical analysis. We also review previously reported cases of pituicytoma in the literature. RESULTS To date, 51 cases of pituicytoma have been reported in addition to our own cases. The natural history and clinical characteristics of this rare tumor are outlined. CONCLUSIONS Macroscopic aspects are variable, and final diagnosis is made from the typical histological and immunohistochemical pattern. The therapy of choice is gross total surgical resection since subtotal removal can lead to local regrowth, but the time to recurrence is unpredictable and highly variable. The role of adjuvant therapy is currently undefined.
Collapse
Affiliation(s)
- Francesca Secci
- Department of Neurosurgery, San Martino University Hospital, Genoa, Italy
| | | | | | | | | |
Collapse
|
14
|
Ellis JA, Tsankova NM, D'Amico R, Ausiello JC, Canoll P, Rosenblum MK, Bruce JN. Epithelioid pituicytoma. World Neurosurg 2011; 78:191.E1-7. [PMID: 22120271 DOI: 10.1016/j.wneu.2011.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 06/01/2011] [Accepted: 09/03/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Pituicytomas are rare tumors of the sellar region that are derived from specialized glial cells called pituicytes. They characteristically exhibit spindle-cell features and fascicular or storiform patterns of growth. No other histological variants of this tumor have been described. CASE DESCRIPTION Here we report a diagnostically challenging case of pituicytoma in a 42-year-old man with a sellar mass arising from the pituitary stalk. On histological examination, the tumor displayed an epithelioid histoarchitecture with no characteristic spindle-cell or fascicular growth features. Strong immunopositivity for the pituicyte marker thyroid transcription factor-1 within tumor cells proved essential for diagnosing this unusual pituicytoma variant. CONCLUSION Pituicytomas may display epithelioid rather than fascicular or storiform histoarchitecture. Epithelioid pituicytoma variants may be diagnosed in cases such as ours in which both the clinical findings and immunohistochemical analysis suggest a tumor derived from pituicytes.
Collapse
Affiliation(s)
- Jason A Ellis
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA.
| | | | | | | | | | | | | |
Collapse
|
15
|
Covington MF, Chin SS, Osborn AG. Pituicytoma, spindle cell oncocytoma, and granular cell tumor: clarification and meta-analysis of the world literature since 1893. AJNR Am J Neuroradiol 2011; 32:2067-72. [PMID: 21960498 DOI: 10.3174/ajnr.a2717] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Pituicytoma, SCO, and GCT are poorly understood entities with confusing nomenclature and undetermined imaging characteristics. Our purpose was to confirm published cases of pituicytoma, SCO, and GCT with the newest 2007 World Health Organization criteria and elucidate imaging findings that distinguish these tumors from common entities such as pituitary adenoma. MATERIALS AND METHODS A literature search identified 145 published cases (81 GCTs, 48 pituicytomas, and 16 SCOs). Case diagnoses were blindly reviewed by a neuropathologist according to the latest WHO criteria, resulting in 112 pathologically documented cases (64 GCTs, 35 pituicytomas, and 13 SCOs). Imaging illustrations from proved cases were reviewed to determine location, configuration, attenuation and signal intensity, and enhancement characteristics. RESULTS Only pituicytomas presented as purely intrasellar lesions (7/33). Most GCTs were purely suprasellar (28/45). All SCOs were both intra- and suprasellar (13/13). Twenty-five percent of pituicytomas (6/22) and GCTs (7/30) appeared separate from the pituitary gland. All SCOs were infiltrating. Seventy-nine percent of entities appeared isointense to brain on T1-weighted image (34/43). Seventy-four percent of pituicytomas enhanced homogeneously (14/19). Twelve of 23 GCTs and 5/7 SCOs enhanced heterogeneously. Most GCTs were hyperattenuated to brain on CT (18/20). Eleven of 13 cases enhanced homogeneously. Visual disturbances were common symptoms for all entities (67/112). Diabetes insipidus was rare (4/112). CONCLUSIONS Pituicytoma may be considered for purely intrasellar masses that are clearly separate from the pituitary gland. GCT should receive consideration for purely suprasellar lesions that are hyperattenuated to brain on CT. SCO should be considered for infiltrating pituitary masses with a mixed intra- and suprasellar location. A history of diabetes insipidus helps to exclude these tumors.
Collapse
Affiliation(s)
- M F Covington
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | | |
Collapse
|
16
|
Ogiwara H, Dubner S, Shafizadeh S, Raizer J, Chandler JP. Spindle cell oncocytoma of the pituitary and pituicytoma: Two tumors mimicking pituitary adenoma. Surg Neurol Int 2011; 2:116. [PMID: 21886889 PMCID: PMC3162801 DOI: 10.4103/2152-7806.83932] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 06/18/2011] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Spindle cell oncocytoma (SCO) and pituicytoma are rare nonfunctioning tumors of the pituitary. Both tumors are low grade and macroscopically indistinguishable from a nonfunctioning pituitary adenoma.We report one case of SCO and one case of pituicytoma and review the previous literature. CASE DESCRIPTION One patient was a 39-year-old man who presented with progressive headache, visual blurring, and polyuria of 3-year duration. He underwent partial resection (30% of the tumor) and postoperative adjuvant radiation therapy. Histopathology revealed SCO. However, after 9 months, the residual tumor grew and partial resection (70% of the tumor) was performed again. Four months after the second surgery, the tumor recurred again and he underwent transsphenoidal resection of the tumor with stable residual tumor to date. The other patient was a 59-year-old man who presented with a 3-month history of visual decline, fatigue, difficulty in writing, and polyuria. He underwent transsphenoidal resection (total) of the tumor. Histopathology revealed pituicytoma. He has been stable without evidence of recurrence for 1 year and 4 months. CONCLUSION To date, there are 15 reported cases of SCO and 45 reported cases of pituicytoma including our cases. An incomplete resection of the tumor was a significant risk factor for recurrence in both SCO and pituicytoma (P = 0.0014 and P = 0.019, respectively). These tumors have a tendency to be hypervascular, which may hamper total resection. Epithelial membrane antigen (EMA) and mitochondria positivity is characteristic to SCO and they are considered to be important immunomarkers to distinguish these tumors.
Collapse
Affiliation(s)
- Hideki Ogiwara
- Division of Neurosurgery, Northwestern University, Feinberg, School of Medicine, Chicago, Illinois, US
| | | | | | | | | |
Collapse
|
17
|
Brandão RACS, Braga MHV, de Souza AA, Reis BL, Faraj de Lima FB. Pituicytoma. Surg Neurol Int 2010; 1:79. [PMID: 21206895 PMCID: PMC3011110 DOI: 10.4103/2152-7806.73802] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 10/24/2010] [Indexed: 11/24/2022] Open
Abstract
Background: Pituicytomas originate from pituicytes, modified glial cells derived from ependymal lineage that are found in the stalk and posterior lobe of pituitary gland. The clinical presentation is similar to other pituitary tumors and imaging exams may suggest pituitary adenoma. The diagnostic is based on histopathological analysis. Surgical treatment can be performed by transsphenoidal approach with good results. The prognostic is good after total tumor resection. Case Description: We describe here the case of a 17-year-old patient with a history of persistent headache and visual disturbances. Magnetic resonance imaging demonstrated an enhancing solid sellar mass suggestive of pituitary adenoma. The intrasellar mass was resected through a transsphenoidal approach and the diagnosis of pituicytoma was made after histopathological analysis. Conclusion: Pituicytomas are rare tumors of the neurohypophysis derived from pituicytes. Their clinical presentation resembles that of non-functional pituitary adenomas, but these two types of tumors are histologically well distinct.
Collapse
|
18
|
Mao Z, Xiao W, Wang H, Li Z, Huang Q, He D, Zhu Y. Pituicytoma: Report of two cases. Oncol Lett 2010; 2:37-41. [PMID: 22870125 DOI: 10.3892/ol.2010.209] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 10/14/2010] [Indexed: 11/05/2022] Open
Abstract
This report describes two cases of pituicytoma. The two patients were female and presented with visual complaints, diabetes insipidus, headaches and menstrual disorders. The imaging characteristic was an intrasellar or suprasellar mass, and one mass originated in the pituitary stalk. The mass showed homogeneous enhancement with contrast administration. A hematoxylin and eosin stain showed a compact structure consisting of elongated, bipolar spindle cells arranged in interlacing fascicles or assuming a storiform pattern. Immunohistochemically, the tumor showed diffuse strong expression of S-100 protein, vimentin and epithelial membrane antigen, and glial fibrillary acidic protein was focally positive. The pituicytoma may have originated in the pituitary stalk and presented with diabetes insipidus, and the differential diagnosis should be compared with the pituitary stalk mass. Bleeding during resection was moderate, and surgery was regarded as the first choice of treatment for pituicytomas.
Collapse
Affiliation(s)
- Zhigang Mao
- Department of Neurosurgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
OBJECTIVE To describe the magnetic resonance imaging features of pituicytomas and identify any specific features that could differentiate this tumor from other sellar/suprasellar masses. METHODS Magnetic resonance images, clinical histories, and pathological findings of 10 patients with pituicytoma were retrospectively reviewed. Reports of clinical history, pathology, and magnetic resonance imaging findings were reviewed for 28 additional histologically proven pituicytoma cases, previously reported in the literature. RESULTS Pituicytomas were mostly round or oval, sharply defined, and located in the sellar and/or suprasellar region. Tumors were generally isointense to gray matter on T1-weighted images and isointense to slightly hyperintense on T2-weighted images, and they enhanced intensely. CONCLUSIONS Magnetic resonance imaging features of pituicytomas overlap with those of other, more common lesions that occur in the region. With the exception of a purely suprasellar-enhancing mass or a clearly defined neurohypophyseal mass separate from the anterior pituitary, the similarity to common tumors such as macroadenomas and meningiomas probably precludes effective prospective diagnosis of pituicytomas.
Collapse
|
20
|
Cunliffe CH, Fischer I, Parag Y, Fowkes ME. State-of-the-Art Pathology: New WHO Classification, Implications, and New Developments. Neuroimaging Clin N Am 2010; 20:259-71. [DOI: 10.1016/j.nic.2010.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
21
|
Spindle cell oncocytoma with late recurrence and unique neuroimaging characteristics due to recurrent subclinical intratumoral bleeding. J Neurooncol 2010; 101:145-54. [DOI: 10.1007/s11060-010-0229-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 05/08/2010] [Indexed: 11/26/2022]
|
22
|
Diagnostic and clinical implications of pituicytoma. J Clin Neurosci 2010; 17:938-43. [PMID: 20403698 DOI: 10.1016/j.jocn.2009.09.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 09/21/2009] [Accepted: 09/29/2009] [Indexed: 10/19/2022]
Abstract
Pituicytoma is a rare, indolent, benign tumor of the sellar and suprasellar region arising from pituicytes of the neurohypophysis. It is most often diagnosed pre-operatively as a pituitary adenoma. We report two patients with pituicytoma operated on at our Institute over 8 years. Imaging of one patient showed a parasellar and medial temporal extension, which has not been reported to our knowledge. The radiological features that help distinguish this low-grade tumor from other sellar and parasellar tumors are discussed along with its distinct histological findings. The authors also review the literature on its clinical presentation, diagnosis, surgical management and outcome.
Collapse
|