Posterior pituitary tumours: the spectrum of a unique entity. A clinical and histological study of a large case series
- 90 Downloads
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.
Cross-sectional study with retrospective data.
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.
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.
KeywordsPosterior pituitary tumours Pituicytoma Granular cell tumours of the neurohypophysis Spindle cell oncocytoma
The authors thank Georgina Petropoulos Nouna for the language review of the paper.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with animals performed by any of the authors. The patient’s confidential information was protected according to national normative. All patients or relatives gave consent regarding participation in the study. This manuscript has been revised for its publication by the Clinical Research Ethics Committee of Bellvitge University Hospital.
- 1.S. Melmed, D. Kleinberg, Pituitary masses and tumors, in Williams Textbook of Endocrinology, ed. by S. Melmed, K.S. Polonsky, P. Reed Larsen, H.M. Kronenberg (Elsevier, Philadelphia, USA. 2016), pp. 232−299Google Scholar
- 2.L.V. Syro, F. Rotondo, O. Moshkin, K. Kovacs, Nonpituitary sellar masses, in The Pituitary, ed. by S. Melmed (Elsevier, London, UK. 2017), pp. 631−641Google Scholar
- 3.O. Mete, M.B.S. Lopes, F. Roncaroli, T. Tihan, S. Yamada, Tumours of the posterior pituitary, in WHO Classifications of Tumours of the Endocrine Organs, ed. by R.V. Lloyd, R.Y. Osamura, G. Kloppel, J. Rosai (WHO Press, Lyon, France. 2017), pp 52−54Google Scholar
- 5.C. Hagel, R. Buslei, M. Buchfelder, R. Fahlbusch, M. Bergmann, A. Giese, J. Flitsch, D.K. Lüdecke, M. Glatzel, W. Saeger, Immunoprofiling of glial tumours of the neurohypophysis suggests a common pituicytic origin of neoplastic cells. Pituitary 20, 211–217 (2017). https://doi.org/10.1007/s11102-016-0762-x CrossRefGoogle Scholar
- 12.I. Vajtai, J. Beck, A. Kappeler, E. Hewer, Spindle cell oncocytoma of the pituitary gland with follicle-like component: organotypic differentiation to support its origin from folliculo-stellate cells. Acta Neuropathol. 122, 253–258 (2011). https://doi.org/10.1007/s00401-011-0835-x CrossRefGoogle Scholar
- 16.T. Yoshimoto, J. Takahashi-Fujigasaki, N. Inoshita, N. Fukuhara, H. Nishioka, S. Yamada, TTF-1-positive oncocytic sellar tumor with follicle formation/ependymal differentiation: non-adenomatous tumor capable of two different interpretations as a pituicytoma or a spindle celloncocytoma. Brain. Tumor Pathol. 32, 221–227 (2015). https://doi.org/10.1007/s10014-015-0219-3 CrossRefGoogle Scholar
- 19.G.N. Fuller, D.J. Brat, P. Wesseling, F. Roncarolli, M.B.S. Lopes, Granular cell tumours of the sellar region. Pituicytoma. Spindle cell oncocytoma, in: WHO Classification of Tumours of the Central Nervous System, ed. by D.N. Louis, H. Ohgaki, H. Wiestler (WHO Press, Lyon, France. 2016), pp. 329−336Google Scholar
- 22.T. Nakazawa, K. Mochizuki, T. Inoue, K. Kasai, I. Tahara, W. Jieying, R. Katoh, Spindle cell oncocytoma of adenohypophysis: report of a case and immunohistochemical review of literature. Pathol. Res. Pract. 212, 222−225 (2016). https://doi.org/10.1016/j.prp.2015.07.014
- 28.W.N. Gibbs, E.S. Monuki, M.E. Linskey, A.N. Hasso, Pituicytoma: diagnostic features on selective carotid angiography and MR imaging. Am. J. Neuroradiol. 27, 1639–1642 (2006)Google Scholar
- 30.S. Alexandrescu, R.E. Brown, N. Tandon, M.B. Bhattacharjee, Neuron precursor features of spindle cell oncocytoma of adenohypophysis. Clin. Lab. Sci. 42, 123–129 (2012)Google Scholar
- 44.E. Guadagno, M. Cervasio, A. Di Somma, M. Califano, D. Solari, M. Del Basso De Caro, Essential role of ultrastructural examination for spindle cell oncocytoma: Case report of a rare neoplasm and review of the literature. Ultrastruct. Pathol. 40, 121–124 (2016). https://doi.org/10.3109/01913123.2016.1157662 CrossRefGoogle Scholar
- 46.J.A. Rotman, W. Kucharczyk, G. Zadeh, T.R. Kiehl, H. Al-Ahmadi, Spindle cell oncocytoma of the adenohypophysis: a case report illustrating its natural historywith 8-year observation and a review of the literature. Clin. Imaging 38, 499–504 (2014). https://doi.org/10.1016/j.clinimag.2014.03.003 CrossRefGoogle Scholar