, Volume 63, Issue 1, pp 36–43 | Cite as

Posterior pituitary tumours: the spectrum of a unique entity. A clinical and histological study of a large case series

  • Fernando Guerrero-PérezEmail author
  • Noemi Vidal
  • Agustina Pia Marengo
  • Carlos Del Pozo
  • Concepción Blanco
  • David Rivero-Celada
  • Juan José Díez
  • Pedro Iglesias
  • Antonio Picó
  • Carles Villabona
Endocrine Surgery



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.


Posterior 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.

Ethical approval

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. 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. 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. 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
  4. 4.
    O. Mete, M.B. Lopes, S.L. Asa, Spindle cell oncocytomas and granular cell tumors of the pituitary are variants of pituicytoma. Am. J. Surg. Pathol. 37, 1694–1699 (2013). CrossRefPubMedGoogle Scholar
  5. 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). CrossRefPubMedGoogle Scholar
  6. 6.
    O. Mete, M.B. Lopes, Overview of the 2017 WHO Classification of Pituitary Tumors. Endocr. Pathol. 28, 228–243 (2017). CrossRefPubMedGoogle Scholar
  7. 7.
    M.F. Covington, S.S. Chin, A.G. Osborn, Pituicytoma, spindle cell oncocytoma, and granular cell tumor: clarification and meta-analysis of the world literature since 1893. Am. J. Neuroradiol. 32, 2067–2072 (2011). CrossRefPubMedGoogle Scholar
  8. 8.
    D. Rivero-Celada, M. Barrera-Rojas, J.Orduna-Martínez, A. Lorente-Muñoz, J. Alfaro-Torres, J. Alberdi-Viñas, Pituitary pituicytoma. Neurocirugia 23, 165–169 (2012). CrossRefPubMedGoogle Scholar
  9. 9.
    F.I. Aranda, P.A. Toro, M.J. González, M. Niveiro, Spindle cell oncocytoma of the pituitary gland. Rev. Esp. Patol. 46, 206–211 (2013). CrossRefGoogle Scholar
  10. 10.
    Y. Takei, S. Seyama, G.S. Pearl, G.T. Tindall, Ultrastructural study of the human neurohypophysis. II. Cellular elements of neural parenchyma, the pituicytes. Cell Tissue Res. 205, 273–287 (1980)CrossRefPubMedGoogle Scholar
  11. 11.
    F. Roncaroli, B.W. Scheithauer, G. Cenacchi, E. Horvath, K. Kovacs, R.V. Lloyd, P. Abell-Aleff, M. Santi, A.J. Yates, ‘Spindle cell oncocytoma’ of the adenohypophysis: a tumor of folliculostellate cells? Am. J. Surg. Pathol. 26, 1048–1055 (2002)CrossRefPubMedGoogle Scholar
  12. 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). CrossRefPubMedGoogle Scholar
  13. 13.
    M. Mlika, H. Azouz, I. Chelly, I.B. Saïd, H. Jemel, S. Haouet, M. Zitouna, N. Kchir, Spindle cell oncocytoma of the adenohypophysis in a woman: a case report and review of the literature. J. Med. Case Rep. 14, 5–64 (2011). CrossRefGoogle Scholar
  14. 14.
    E.B. Lee, T. Tihan, B.W. Scheithauer, P.J. Zhang, N.K. Gonatas, Thyroid transcription factor 1 expression in sellar tumors: a histogenetic marker? J. Neuropathol. Exp. Neurol. 68, 482–488 (2009). CrossRefPubMedGoogle Scholar
  15. 15.
    Z. Saeed Kamil, G. Sinson, H. Gucer, S.L. Asa, O. Mete, TTF1 expressing sellar neoplasm with ependymal rosettes and oncocytic change: mixedependymal and oncocytic variant pituicytoma. Endocr. Pathol. 25, 436–438 (2014). CrossRefPubMedGoogle Scholar
  16. 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). CrossRefPubMedGoogle Scholar
  17. 17.
    M.B.S. Lopes, The 2017 World Health Organization classification of tumors of the pituitary gland: a summary. Acta Neuropathol. 134, 521–535 (2017). CrossRefPubMedGoogle Scholar
  18. 18.
    B.W. Scheithauer, B. Swearingen, E.T. Whyte, P.K. Auluck, A.O. Stemmer-Rachamimov, Ependymoma of the sella turcica: a variant of pituicytoma. Hum. Pathol. 40, 435–440 (2009). CrossRefPubMedGoogle Scholar
  19. 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
  20. 20.
    J. Wang, Z. Liu, J. Du, Y. Cui, J. Fang, L. Xu, G. Li, The clinicopathological features of pituicytoma and the differential diagnosis of sellar glioma. Neuropathology 36, 432–440 (2016). CrossRefPubMedGoogle Scholar
  21. 21.
    A.A. Cohen-Gadol, M.A. Pichelmann, M.J. Link, B.W. Scheithauer, K.N. Krecke, W.F. Young WF Jr, J. Hardy, C. Giannini, Granular cell tumor of the sella and suprasellar region: clinicopthologic study of 11 cases and literature review. Mayo Clin. Proc. 78, 567–573 (2003)CrossRefPubMedGoogle Scholar
  22. 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).
  23. 23.
    A. Pirayesh Islamian, R. Buslei, W. Saeger, R. Fahlbusch, Pituicitoma: overview of treatment strategies and outcome. Pituitary 15, 227–236 (2012). CrossRefPubMedGoogle Scholar
  24. 24.
    Q. Mu, J. Yu, L. Qu, X. Hu, H. Gao, P. Liu, X. Zheng, Y. Sun, H. Huang, Spindle cell oncocytoma of the adenohypophysis: two case reports and a review of the literature. Mol. Med. Rep. 12, 871–876 (2015). CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    M. Losa, W. Saeger, P. Mortini, C. Pandolfi, M.R. Terreni, G. Taccagni, M. Giovanelli, Acromegaly associated with a granular cell tumor of the neurohypophysis: a clinical and histological study. Case report. J. Neurosurg. 93, 121–126 (2000)CrossRefPubMedGoogle Scholar
  26. 26.
    T.W. Chang, C.Y. Lee, S.M. Jung, H.Y. Lai, C.T. Chen, M.C. Yeap, C.C. Chuang, P.W. Hsu, C.N. Chang, P.H. Tu, S.T. Lee, Correlations between clinical hormone and pathological features of pituicytoma. Br. J. Neurosurg. 11, 1–8 (2018). CrossRefGoogle Scholar
  27. 27.
    Z. Feng, Z. Mao, Z. Wang, B. Liao, Y. Zhu, H. Wang, Non-adenomatous pituitary tumours mimicking functioning pituitary adenomas. Br. J. Neurosurg. 18, 1–5 (2018). CrossRefGoogle Scholar
  28. 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)PubMedGoogle Scholar
  29. 29.
    H.L. Liu, B.Y. Huang, M.S. Zhang, H.R. Wang, Y.M. Qu, C.J. Yu, Sellar and suprasellar granular cell tumor of neurohypophysis. Chin. Med. J. (Engl.). 130, 741–743 (2017). CrossRefPubMedPubMedCentralGoogle Scholar
  30. 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
  31. 31.
    W.A. Thiryayi, K.K. Gnanalingham, H. Reid, A. Heald, T. Kearney, Pituicytoma: a misdiagnosed benign tumour of the posterior pituitary. Br. J. Neurosurg. 21, 47–48 (2007)CrossRefPubMedGoogle Scholar
  32. 32.
    M. Feng, J.D. Carmichael, V. Bonert, S. Bannykh, A.N. Mamelak, Surgical management of pituicytomas: case series and comprehensive literature review. Pituitary 17, 399–413 (2014). CrossRefPubMedGoogle Scholar
  33. 33.
    A. Iglesias, M. Arias, J. Brasa, C. Páramo, C. Conde, R. Fernandez, MR imaging findings in granular cell tumor of the neurohypophysis: a difficult preoperative diagnosis. Eur. Radiol. 10, 1871–1873 (2000)CrossRefPubMedGoogle Scholar
  34. 34.
    Z.I. Hasiloglu, E. Ure, N. Comunoglu, N. Tanriover, B. Oz, N. Gazioglu, I. Mihmanli, New readiological clues in the diagnosis of spindle cell oncocytoma of the adenohypophysis. Clin. Radiol. 71, 937.e5–937 (2016). CrossRefGoogle Scholar
  35. 35.
    R.J. Benveniste, D. Purohit, H. Byun, Pituicytoma presenting with spontaneous hemorrhage. Pituitary 9, 53–58 (2006)CrossRefPubMedGoogle Scholar
  36. 36.
    H. Fujisawa, Y. Tohma, N. Muramatsu, S. Kida, Y. Kaizaki, H. Tamamura, Spindle cell oncocytoma of the adenohypophysis with marked hypervascularity. Case Report. Neurol. Med Chir. (Tokyo). 52, 594–598 (2012)CrossRefPubMedGoogle Scholar
  37. 37.
    S.J. Park, Y.H. Chang, N.R. Yang, E.K. Seo, Granular cell tumor in the pituitary stalk: a case report. Brain Tumor Res. Treat. 3, 60–63 (2015). CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    F. Gagliardi, A. Spina, L.R. Barzaghi, M. Bailo, M. Losa, M.R. Terreni, P. Mortini, Suprasellar granular cell tumor of the neurohypophysis: surgical outcome of a very rare tumor. Pituitary 19, 277–285 (2016). CrossRefPubMedGoogle Scholar
  39. 39.
    M.T. Borges, K.O. Lillehei, B.K. Kleinschmidt-DeMasters, Spindle cell oncocytoma with late recurrence and unique neuroimaging characteristics due to recurrent subclinical intratumural bleeding. J. Neurooncol. 101, 145–154 (2011). CrossRefPubMedGoogle Scholar
  40. 40.
    D. Billeci, E. Marton, E. Giordan, V. Carraro, M. Ronzon, S. Rossi, Spindle cell oncocytoma: report of two cases with massive bleeding and review of the literature. J. Clin. Neurosci. 39, 39–44 (2017). CrossRefPubMedGoogle Scholar
  41. 41.
    C.C. Zygourakis, J.D. Rolston, H.S. Lee, C. Partow, S. Kunwar, M.K. Aghi, Pituicytomas and spindle cell oncocytomas: modern case series from the University of California, San Francisco. Pituitary 18, 150–158 (2015). CrossRefPubMedGoogle Scholar
  42. 42.
    O. Kloub, A. Perry, P.H. Tu, M. Lipper, M.B. Lopes, Spindle cell oncocytoma of the adenohypophysis: report of two recurrent cases. Am. J. Surg. Pathol. 29, 247–253 (2005)CrossRefPubMedGoogle Scholar
  43. 43.
    X. Kong, D. Li, Y. Kong, D. Zhong, Malignant adenohypophysis spindle cell oncocytoma with repeating recurrences and a high Ki-67 index. Medicine 96, e5657 (2017). CrossRefPubMedPubMedCentralGoogle Scholar
  44. 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). CrossRefPubMedGoogle Scholar
  45. 45.
    I. Vajtai, R. Sahli, A. Kappeler, Spindle cell oncocytoma of the adenohypophysis: report of a case with a 16-year follow-up. Pathol. Res. Pract. 202, 745–750 (2006)CrossRefPubMedGoogle Scholar
  46. 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). CrossRefPubMedGoogle Scholar
  47. 47.
    K. Schmalisch, J. Schittenhelm, F.H. Ebner, F. Beuschlein, J. Honegger, R. Beschorner, Pituicytoma in a patient with Cushing’s disease: case report and review of the literature. Pituitary 15, S10–S16 (2012). CrossRefPubMedGoogle Scholar
  48. 48.
    A.E. Romero-Rojas, M.A. Melo-Uribe, P.A. Barajas-Solano, S.I. Chinchilla-Olaya, L.I. Escobar, D.M. Hernandez-Walteros, Spindle cell oncocytoma of the adenohypophysis. Brain Tumor Pathol. 28, 359–364 (2011). CrossRefPubMedGoogle Scholar
  49. 49.
    B. Schaller, E. Kirsch, M. Tolnay, T. Mindermann, Symptomatic granular cell tumor of the pituitary gland: case report and review of the literature. Neurosurgery 42, 166–170 (1998)CrossRefPubMedGoogle Scholar
  50. 50.
    S. Dahiya, C. Sarkar, E.T. Hedley-Whyte, M.C. Sharma, N.T. Zervas, E. Sridhar, D.N. Louis, Spindle cell oncocytoma of the adenohypophysis: report of two cases. Acta Neuropathol. 110, 97–99 (2005)CrossRefPubMedGoogle Scholar
  51. 51.
    R.J. Kowalski, R.A. Prayson, M.R. Mayberg, Pituicytoma. Ann. Diagn. Pathol. 8, 290–294 (2004)CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Fernando Guerrero-Pérez
    • 1
    Email author
  • Noemi Vidal
    • 2
  • Agustina Pia Marengo
    • 1
  • Carlos Del Pozo
    • 3
  • Concepción Blanco
    • 4
  • David Rivero-Celada
    • 5
  • Juan José Díez
    • 6
  • Pedro Iglesias
    • 6
  • Antonio Picó
    • 7
  • Carles Villabona
    • 1
  1. 1.Department of EndocrinologyHospital Universitari de BellvitgeBarcelonaSpain
  2. 2.Department of PathologyHospital Universitari de BellvitgeBarcelonaSpain
  3. 3.Department of EndocrinologyHospital Universitari Mutua TerrassaBarcelonaSpain
  4. 4.Department of EndocrinologyHospital Universitario Príncipe de AsturiasMadridSpain
  5. 5.Department of NeurosurgeryHospital Universitario Miguel ServetZaragozaSpain
  6. 6.Department of EndocrinologyHospital Universitario Puerta de HierroMadridSpain
  7. 7.Department of EndocrinologyHospital General Universitario de AlicanteAlicanteSpain

Personalised recommendations