Spindle cell oncocytoma of the pituitary and pituicytoma: Two tumors mimicking pituitary adenoma
ABSTRACT 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.
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.
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.
Article: Pituicitoma hipofisario[Show abstract] [Hide abstract]
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.Neurocirugia (Asturias, Spain) 07/2012; 23(4):165–169. DOI:10.1016/j.neucir.2012.03.001 · 0.32 Impact Factor
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ABSTRACT: Pituicytoma is a rare low-grade tumor (WHO Grade I) of pituicytes involving the sellar-suprasellar region, and originating from the specialized glial cells of the neurohypophysis. Clinically and radiologically, they closely mimic pituitary adenoma or meningioma. Diagnosis requires histopathological examination of the resected tissue. This uncommon glial neoplasm is a rarity, with only 57 cases reported in the literature so far. We report three cases of pituicytoma (aged between 7 and 24 years) presenting with reduced vision, headache and features of hypercortisolism in one case. Radiologically, these lesions mimicked meningioma, hypothalamic chiasmatic glioma and pituitary microadenoma, respectively. The second case is a 7-year-old girl, the youngest case on record. Since this tumor is uncommon, it is frequently misdiagnosed. Awareness of this entity is essential for planning management and treatment. We present a brief review of all cases reported in the medical literature, and describe the clinical symptomatology, associated endocrinological abnormalities, imaging characteristics, behavior and outcome.Pathology - Research and Practice 12/2012; 209(1). DOI:10.1016/j.prp.2012.10.006 · 1.56 Impact Factor
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ABSTRACT: This article reviews recent literature on sellar region masses that most closely mimic non-secretory pituitary adenomas: hypophysitis, pituicytoma, spindle cell oncocytoma, and granular cell tumor of neurohypophysis. Even today, these 4 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-CTLA4 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 (38, 39, 119). The finding that immunohistochemical staining for thyroid transcription factor-1 (TTF-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.Brain Pathology 05/2013; 23(5). DOI:10.1111/bpa.12068 · 4.35 Impact Factor