A recurrent case of pituicytoma 16 years later

BACKGROUND

Pituicytoma is a rare; slow-growing primary tumour originating from the glial cells of the neurohypophysis. It was classed as a low-grade (grade I) central nervous system tumour by the World Health Organization in 2007. We present the case of a 71-year-old man with a previous history of sellar meningioma who underwent surgical resection of pituicytoma by transphenoidal hypophysectomy.

METHOD

We conducted a literature search using Medline EMBASE and the Cochrane Database of Systematic Reviews using the Ovid search engines. Key words searched were 'pituitary gland', 'pituicytoma', 'neurohypophysis'. Patient records and imaging were obtained from the Royal Stoke University Hospital database.

RESULTS

A 71-year-old man with a background of sellar meningioma 16 years previously was found to have a pituitary fossa tumour on surveillance magnetic resonance imaging. Differential diagnosis was pituitary adenoma. Endoscopic transphenoidal hypophysectomy was performed. Histology was consistent with pituicytoma. As a result of this histology from his initial tumour was re-examined and was amended to pituicytoma, indicating a recurrence.

CONCLUSION

Pituicytoma is a benign, slow growing lesion of the posterior pituitary. Brat et al diagnosed it as a distinct entity in 2000 and it was listed as a World Health Organization classification grade I tumour in 2007. It can be mistaken for pituitary adenoma owing to its similar clinical presentation. Complete excision of the tumour by transphenoidal hypophysectomy is an effective management for pituicytoma as demonstrated in this case.

Use of laser, otoendoscopy and facial nerve monitoring in otological surgery: United Kingdom survey

Newer surgical tools, which have been widely accepted as important adjuncts in otological surgery, include the laser, otoendoscopy and facial nerve monitoring. A confidential postal questionnaire survey was carried out to evaluate the usage of these newer techniques among the Consultant members of the British Association of Otorhinolaryngology-Head and Neck Surgery. Our study revealed that the usage of otoendoscopy, laser and/or facial nerve monitoring is not as widespread as might be thought among otological surgeons in the United Kingdom.

An analysis of diagnostic delay in unilateral facial paralysis

Bell’s palsy or idiopathic facial palsy is the commonest cause of unilateral lower motor neuron facial palsy. Misdiagnosis of facial nerve palsy as Bell’s palsy is still seen in clinical practice. The clinician should always consider the possibility of a potentially serious underlying pathology before making the diagnosis of Bell’s palsy.

We present a series of 13 patients referred to our ENT department with an initial diagnosis of Bell’s palsy. Further clinical examination and investigation revealed the underlying cause. Many had additional symptoms and signs related to the ear.

In all patients with unilateral facial palsy a detailed history should be taken and thorough clinical examination carried out. Where no recovery occurs within the expected time period further radiological investigations such as computerized axial tomography (CT) and magnetic resonance imaging (MRI) should be performed. Current scanning techniques provide good quality images, which can show occult lesions of the temporal bone, internal acoustic canal and/or cerebellopontine angle. Radiologists with a special interest and experience in otoneurological radiology should ideally report these images, and a close co-operation between ENT surgeon and radiologist is essential in arriving at a proper diagnosis.

Diagnostic tools in pseudohypacusis in children

Pseudohypacusis is the term used for a non-organic or functional hearing loss. The mainstay of diagnosis is a lack of consistency in audiological testing. It is usually easier to diagnose in children than in adults, as children are less able to reproduce consistently erroneous results on repeated testing. Nevertheless, the diagnosis is often missed in children, probably due to a lack of awareness of the condition. In a previous study from our department, we highlighted the usefulness of speech audiometry in establishing the diagnosis. However, with the advent of otoacoustic emissions testing, we have changed the emphasis of our testing protocol. Using otoacoustic emissions, the diagnosis of pseudohypacusis can be established quickly and easily.

Informed consent for middle ear operations: a United Kingdom survey

Otorhinolaryngologists throughout the UK routinely perform middle ear operations. Although the risk of serious complications in the hands of a well-trained surgeon is very low, some of the complications of middle ear surgery are devastating to the patient viz. facial nerve palsy and complete hearing loss. The subject of informed consent is highly topical because of clinical governance and medico-legal implications. We have audited the practice of the Consultant members of the British Association of Otorhinolaryngologists-Head and Neck Surgeons via a postal questionnaire with regards to their consenting process prior to middle ear operations. Our study looked at the practice of discussing different complications and the complication rates, the person consenting, time spent on consenting, and the documentation. We found that wide variations exist in the consenting process. The implications of the results are discussed. This study is particularly pertinent at the present time with the implementation of the new consenting standards document published by the Department of Health.

Deliberate removal of incisor teeth to allow access for laryngoscopy

This paper describes a clinical situation where it was impossible to obtain a biopsy of a lesion at the anterior commissure in a patient with progressive hoarseness of voice using standard microlaryngoscopy techniques. Due to anatomical difficulties and a histological suggestion of laryngeal papillomatosis the incisor teeth were deliberately removed to allow an adequate view of the larynx and to facilitate further access.

Juvenile xanthogranuloma of the nasal cavity

Juvenile xanthogranuloma is a benign, normolipaemic, self-healing condition and a type of histiocytosis that occurs most frequently in infants and children. This condition usually presents with solitary or multiple cutaneous lesions and occasionally with visceral lesions. We report a case of juvenile xanthogranuloma occurring in the nasal cavity. We believe this is the first report, in the English literature, of juvenile xanthogranuloma occurring in this site.