Journal of Endocrinological Investigation

, Volume 42, Issue 4, pp 371–384 | Cite as

Clinical features, diagnosis and therapy of pituicytoma: an update

  • F. J. Salge-ArrietaEmail author
  • R. Carrasco-Moro
  • V. Rodríguez-Berrocal
  • H. Pian
  • J. S. Martínez-San Millán
  • P. Iglesias
  • L. Ley-Urzáiz



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.


Retrospective review of case reports published in the scientific literature to date, including a new illustrative example treated in our department.


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.


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.


Hypothalamus Pituicytoma Pituitary Tumor Transsphenoidal surgery 



We would like to acknowledge the assistance of Prof. Eduardo E. Espinosa during the elaboration of the manuscript in English language.

Compliance with ethical standards

Conflict of interest

The authors report no conflicts of interest or financial disclosures/nothing to declare.

Ethical approval

This study was ellaborated in accordance with the ethical standards currently in force, including those from our institutional research committee and the 1964 Helsinki declaration (and its later amendments). For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individuals participants included in the study.

Supplementary material

Online Resource 1. Video showing a description of most important steps in the surgical approach of a PT through an endonasal endoscopic transsphenoidal corridor (AVI 13570 kb)


  1. 1.
    Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Ellison DW, Figarella-Branger D, Perry A, Reifenberger G, von Deimling A (2016) WHO classification of tumours of the central nervous system. IARC, LyonGoogle Scholar
  2. 2.
    Lloyd RV, Osamura RY, Klöppel G, Rosai J (2017) WHO classification of tumours of endocrine organs. IARC, LyonGoogle Scholar
  3. 3.
    UK-TIA Study Group (1988) The UK-tia aspirin trial: Interim results. Br Med J 296:316–320CrossRefGoogle Scholar
  4. 4.
    Shenoy AS, Desai HM, Mehta JK (2013) Pituicytoma: a case report with literature revisited. Indian J Pathol Microbiol 56:180–181CrossRefPubMedGoogle Scholar
  5. 5.
    Liss L, Kahn EA (1958) Pituicytoma, tumor of the sella turcica; a clinicopathological study. J Neurosurg 15:481–488CrossRefPubMedGoogle Scholar
  6. 6.
    Hurley TR, D’Angelo CM, Clasen RA, Wilkinson SB, Passavoy RD (1994) Magnetic resonance imaging and pathological analysis of a pituicytoma: case report. Neurosurgery 35:314–317CrossRefPubMedGoogle Scholar
  7. 7.
    Brat DJ, Scheithauer BW, Staugaitis SM, Holtzman RNN, Morgello S, Burger PC (2000) Pituicytoma: a distinctive low-grade glioma of the neurohypophysis. Am J Surg Pathol 24:362–368CrossRefPubMedGoogle Scholar
  8. 8.
    Brandão RA, Braga MH, de Souza AA, Reis BL, Faraj de Lima FB (2010) Pituicytoma. Surg Neurol Int 1:79CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Jenevein EP (1964) A neurohypophyseal tumor originating from pituicytes. Am J Clin Pathol 41:522–526CrossRefPubMedGoogle Scholar
  10. 10.
    Massie AP (1979) A granular-cell pituicytoma of the neurohypophysis. J Pathol 129:53–56CrossRefPubMedGoogle Scholar
  11. 11.
    Schmalisch K, Schittenhelm J, Ebner FH, Beuschlein F, Honegger J, Beschorner R (2012) Pituicytoma in a patient with Cushing’s disease: case report and review of the literature. Pituitary 15:S10–S16CrossRefPubMedGoogle Scholar
  12. 12.
    Takei HGJ (2005) Pituicytoma incidentally found at autopsy. Pathol Int 55:745–749CrossRefPubMedGoogle Scholar
  13. 13.
    Furtado SV, Ghosal N, Venkatesh PK, Gupta K, Hegde AS (2010) Diagnostic and clinical implications of pituicytoma. J Clin Neurosci 17:938–943CrossRefPubMedGoogle Scholar
  14. 14.
    Lee EB, Tihan T, Scheithauer BW, Zhang PJ, Gonatas NK (2009) Thyroid transcription factor 1 expression in sellar tumors: a histogenetic marker? J Neuropathol Exp Neurol 68:482–488CrossRefPubMedGoogle Scholar
  15. 15.
    Rivero-Celada D, Barrera-Rojas M, Orduña-Martínez J, Lorente-Muñoz A, Alfaro-Torres J, Alberdi-Viñas J (2012) Pituitary pituicytoma. Neurocirugia (Astur) 23:165–169 (Spanish) CrossRefGoogle Scholar
  16. 16.
    Scheithauer BW, Swearingen B, Whyte ET, Auluck PK, Stemmer-Rachamimov AO (2009) Ependymoma of the sella turcica: a variant of pituicytoma. Hum Pathol 40:435–440CrossRefPubMedGoogle Scholar
  17. 17.
    Secci F, Merciadri P, Rossi DC, D’Andrea A, Zona G (2012) Pituicytomas: radiological findings, clinical behavior and surgical management. Acta Neurochir (Wien) 154:649–657CrossRefGoogle Scholar
  18. 18.
    Hagel C, Buslei R, Buchfelder R, Fahlbusch R, Bergmann M, Giese A, Flitsch J, Ludecke DK, Glatzel M, Saeger W (2017) Inmunoprofiling of glial tumours of the neurohypophysis suggests a common pituicytic origin of neoplastic cells. Pituitary 20:211–217CrossRefPubMedGoogle Scholar
  19. 19.
    Hewer E, Beck J, Kellner-Weldon F, Vajtai I (2015) Suprasellar chordoid neoplasm with expression of thyroid transcription factor 1: evidence that chordoid glioma of the third ventricle and pituicytoma may form part of a spectrum of lineage-related tumors of the basal forebrain. Hum Pathol 46:1045–1049CrossRefPubMedGoogle Scholar
  20. 20.
    Mete O, Lopes MB, Asa SL (2013) Spindle cell oncocytomas and granular cell tumors of the pituitary are variants of pituicytoma. Am J Surg Pathol 37:1694–1699CrossRefPubMedGoogle Scholar
  21. 21.
    Mete O, Lopes MB (2017) Overview of the 2017 WHO classification of pituitary tumors. Endocr Pathol 28:228–243CrossRefPubMedGoogle Scholar
  22. 22.
    Scheithauer BW, Horvath E, Kovacs K (1992) Ultrastructure of the neurohypophysis. Microsc Res Tech 20:177–186CrossRefPubMedGoogle Scholar
  23. 23.
    Shibuya M (2018) Welcoming the new WHO classification of pituitary tumors 2017: revolution in TTF-1-positive posterior pituitary tumors. Brain Tumor Pathol. CrossRefPubMedGoogle Scholar
  24. 24.
    Mete O, Lopes MBS, Roncaroli F, Tihan T, Yamada S (2017) Tumours of the posterior pituitary. In: Lloyd RV, Osamura RY, Kloppel G, Rosai J (eds) WHO classification of tumours of endocrine organs, 4th edn. International Agency for Research on Cancer, Lyon, pp 52–54Google Scholar
  25. 25.
    Wang J, Liu Z, Du J, Cui Y, Fang J, Xu L, Li G (2016) The clinicopathological features of pituicytoma and the differential diagnosis of sellar glioma. Neuropathology 36:432–440CrossRefPubMedGoogle Scholar
  26. 26.
    El Hussein S, Vincentelli C (2017) Pituicytoma: review of commonalities and distinguishing features among TTF-1 positive tumors of the central nervous system. Ann Diagn Pathol 29:57–61CrossRefPubMedGoogle Scholar
  27. 27.
    Ellis JA, Tsankova NM, D’Amico R, Ausiello JC, Canoll P, Rosenblum MK, Bruce JN (2012) Epithelioid pituicytoma. World Neurosurg 78:191CrossRefPubMedGoogle Scholar
  28. 28.
    Cenacchi G, Giovenali P, Castrioto C, Giangaspero F (2001) Pituicytoma: ultrastructural evidence of a possible origin from folliculo-stellate cells of the adenohypophysis. Ultrastruct Pathol 25:309–312CrossRefPubMedGoogle Scholar
  29. 29.
    Neidert MC, Leske H, Burkhardt JK, Kollias SS, Capper D, Schrimpf D (2016) Synchronous pituitary adenoma and pituicytoma. Hum Pathol 47:138–143CrossRefPubMedGoogle Scholar
  30. 30.
    Saeed Kamil Z, Sinson G, Gucer H, Asa SL, Mete O (2014) TTF-1 expressing sellar neoplasm with ependymal rosettes and oncocytic change: mixed ependymal and oncocytic variant pituicytoma. Endocr Pathol 25:436–438CrossRefPubMedGoogle Scholar
  31. 31.
    Uesaka T, Miyazono M, Nishio S, Iwaki T (2002) Astrocytoma of the pituitary gland (pituicytoma): case report. Neuroradiology 44:123–125CrossRefPubMedGoogle Scholar
  32. 32.
    Yilmaz Ö, Turan A, Yiğit H, Duymuş M, Koşar U (2012) Case of pituicytoma in childhood. Childs Nerv Syst 28:11–12CrossRefPubMedGoogle Scholar
  33. 33.
    Saeger W (2010) Bericht über das Hypophysenregister im Jahre 2009 der Arbeitsgemeinschaft Hypophyse und Hypophysentumore der DGE. Endokrinologie Informationen 34:59–67 (German) Google Scholar
  34. 34.
    Pirayesh Islamian A, Buslei R, Saeger W, Fahlbusch R (2012) Pituicytoma: overview of treatment strategies and outcome. Pituitary 15:227–236CrossRefPubMedGoogle Scholar
  35. 35.
    Benveniste RJ, Purohit D, Byun H (2006) Pituicytoma presenting with spontaneous hemorrhage. Pituitary 9:53–58CrossRefPubMedGoogle Scholar
  36. 36.
    Nakasu Y, Nakasu S, Saito A, Horiguchi S, Kameya T (2006) Pituicytoma. Two case reports. Neurol Med Chir (Tokyo) 46:152–156CrossRefGoogle Scholar
  37. 37.
    Chakraborti S, Mahadevan A, Govindan A, Sridhar K, Mohan NVS, Satish IR, Rudrappa S, Mangshetty S, Shankar SK (2013) Pituicytoma: report of three cases with review of literature. Pathol Res Pract 209:52–58CrossRefPubMedGoogle Scholar
  38. 38.
    Guo X, Fu H, Kong X, Gao L, Wang W, Ma W, Yao Y, R Wang, Xing B (2016) Pituicytoma coexisting with corticotroph hyperplasia: literature review with one case report. Medicine (Baltimore) 95:e3062CrossRefGoogle Scholar
  39. 39.
    Yang X, Liu X, Li W, Chen D (2016) Pituicytoma: a report of three cases and literature review. Oncol Lett 12:3417–3422CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Schultz AB, Brat DJ, Oyesiku NM, Hunter SB (2001) Intrasellar pituicytoma in a patient with other endocrine neoplasms. Arch Pathol Lab Med 125:527–530PubMedGoogle Scholar
  41. 41.
    Convington MF, Chin SS, Osborn AG (2011) Pituicytoma, spindle cell oncocytoma, and granular cell tumor: clarification and meta-analysis of the world literature since 1893. AJNR Am J Neuroradiol 32:2067–2072CrossRefGoogle Scholar
  42. 42.
    Osborn AG (2013) Sellar neoplasms and tumor-like lesions. In: Osborn AG (ed) Osborn’s brain. Imaging, pathology and anatomy. Amirsys, Canada, pp 681–726Google Scholar
  43. 43.
    Chu J, Yang Z, Meng Q, Yang J (2011) Pituicytoma: case report and literature review. Br J Radiol 84:e55–e57CrossRefPubMedGoogle Scholar
  44. 44.
    Gibbs WN, Monuki ES, Linskey ME, Hasso AN (2006) Pituicytoma: diagnostic features on selective carotid angiography and MR imaging. AJNR Am J Neuroradiol 27:1639–1642PubMedGoogle Scholar
  45. 45.
    Wolfe SQ, Bruce J, Morcos JJ (2008) Pituicytoma: case report. Neurosurgery 63:E173–E174CrossRefPubMedGoogle Scholar
  46. 46.
    Pascual JM, Prieto R, Carrasco R, Castro-Dufourny I, Strauss S, Gil-Simoes R, Barrios L (2014) The 2013 Sixto Obrador Award. A triple-axis topographical model for surgical planning of craniopharyngiomas. Part II: anatomical and neuroradiological evidence to define triple-axis topography and its usefulness in predicting individual surgical risk. Neurocirugia (Astur) 25:211–239 (Spanish) CrossRefGoogle Scholar
  47. 47.
    Zygourakis CC, Rolston JD, Lee HS, Partow C, Kunwar S, Aghi MK (2015) Pituicytomas and spindle cell oncocytomas: modern case series from the University of California, San Francisco. Pituitary 18:150–158CrossRefPubMedGoogle Scholar
  48. 48.
    Chen KTK (2005) Crush cytology of pituicytoma. Diagn Cytopathol 33:255–257CrossRefPubMedGoogle Scholar
  49. 49.
    Katsuta T, Inoue T, Nakagaki H, Takeshita M, Morimoto K, Iwaki T (2003) Distinctions between pituicytoma and ordinary pilocytic astrocytoma. Case report. J Neurosurg 98:404–406CrossRefPubMedGoogle Scholar
  50. 50.
    Mao Z, Xiao W, Wang H, Li Z, Huang Q, He D, Zhu Y (2011) Pituicytoma: report of two cases. Oncol Lett 2:37–41CrossRefPubMedGoogle Scholar
  51. 51.
    Peron S, Mandelli J, Galante N, Colombo S, Locatelli D (2017) Recurrent pituicytoma with pseudoaneurysm: report of a challenging case. World Neurosurg 105:1043e1–1043e5CrossRefGoogle Scholar
  52. 52.
    Zunarelli E, Casaretta GL, Rusev B, Lupi M (2011) Pituicytoma with atypical histological features: are they predictive of unfavourable clinical course? Pathology 43:389–394CrossRefPubMedGoogle Scholar
  53. 53.
    Kowalski RJ, Prayson RA, Mayberg MR (2004) Pituicytoma. Ann Diagn Pathol 8:290–294CrossRefPubMedGoogle Scholar
  54. 54.
    Ulm AJ, Yachnis AT, Brat DJ, Rhoton AL Jr (2004) Pituicytoma: report of two cases and clues regarding histogenesis. Neurosurgery 54:753–757CrossRefPubMedGoogle Scholar
  55. 55.
    Zhang F, Chen J, You C (2010) Pituicytoma: case report and review of the literature. Neurol India 58:799–801CrossRefPubMedGoogle Scholar
  56. 56.
    Mende KC, Matschke J, Burkhardt T, Saeger W, Buslei R, Buchfelder M, Fahlbusch R, Westphal M, Flitsch J (2017) Pituicytoma—an outlook on possible targeted therapies. CNS Neurosci Ther 23:620–626CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Karamchandani J, Syro LV, Uribe H, Horvath E, Kovacs K (2012) Pituicytoma of the neurohypophysis: analysis of cell proliferation biomarkers. Can J Neurol Sci 39:835–837CrossRefPubMedGoogle Scholar
  58. 58.
    Figarella-Branger D, Dufour H, Fernandez C, Bouvier-Labit C, Grisoli F, Pellissier JF (2002) Pituicytomas, a mis-diagnosed benign tumor of the neurohypophysis: report of three cases. Acta Neuropathol 104:313–319PubMedGoogle Scholar
  59. 59.
    Shah B, Lipper MH, Laws ER, Lopes MB, Spellman MJ Jr (2005) Posterior pituitary astrocytoma: a rare tumor of the neurohypophysis: a case report. AJNR Am J Neuroradiol 26:1858–1861PubMedGoogle Scholar
  60. 60.
    Thiryayi WA, Gnanalingham Mr KK, Reid H, Heald A, Kearney T (2007) Pituicytoma: a misdiagnosed benign tumour of the posterior pituitary. Br J Neurosurg 21:47–48CrossRefPubMedGoogle Scholar
  61. 61.
    Newnham HH, Rivera-Woll LM (2008) Images in clinical medicine. Hypogonadism due to pituicytoma in identical twin. N Engl J Med 359:2824CrossRefPubMedGoogle Scholar
  62. 62.
    Orrego JJ (2009) Pituicytoma and isolated ACTH deficiency. Pituitary 12:371–372CrossRefPubMedGoogle Scholar
  63. 63.
    Zhi L, Yang L, Quan H, Bai-ning L (2009) Pituicytoma presenting with atypical histological features. Pathology 41:505–509CrossRefPubMedGoogle Scholar
  64. 64.
    Phillips JJ, Misra A, Feuerstein BG, Kunwar S, Tihan T (2010) Pituicytoma characterization of a unique neoplasm by histology, immunohistochemistry, ultrastructure, and array-based comparative genomic hybridization. Arch Pathol Lab Med 134:1063–1069PubMedPubMedCentralGoogle Scholar
  65. 65.
    Hammoud DA, Munter FM, Brat DJ, Pomper MG (2010) Magnetic resonance imaging features of pituicytomas: analysis of 10 cases. J Comput Assist Tomogr 34:757–761CrossRefPubMedGoogle Scholar
  66. 66.
    Grote A, Kovacs A, Clusmann H, Becker AJ, Niehusmann P (2010) Incidental pituicytoma after accidental head trauma—case report and review of literature. Clin Neuropathol 29:127–133CrossRefPubMedGoogle Scholar
  67. 67.
    Ogiwara H, Dubner S, Shafizadeh S, Raizer J, Chandler JP (2011) Spindle cell oncocytoma of the pituitary and pituicytoma: two tumors mimicking pituitary adenoma. Surg Neurol Int 2:116CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Kwon MJ, Suh YL (2011) Pituicytoma with unusual histological features. Pathol Int 61:598–602CrossRefPubMedGoogle Scholar
  69. 69.
    Huang Y, Quan J, Su H, Hu HX, Wang F (2012) 40-year-old female with a sellar mass. Brain Pathol 22(6):871–874CrossRefPubMedGoogle Scholar
  70. 70.
    Huynh N, Stemmer-Rachamimov AO, Swearingen B, Cestari DM (2012) Decreased vision and junctional scotoma from pituicytoma. Case Rep Ophthalmol 3:190–196CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Kosuge Y, Hiramoto J, Morishima H, Tanaka Y, Hashimoto T (2012) 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 18:306CrossRefGoogle Scholar
  72. 72.
    Tian Y, Yue S, Jia G, Zhang Y (2013) Childhood giant pituicytoma: a report and review of the literature. Clin Neurol Neurosurg 115:1943–1950CrossRefPubMedGoogle Scholar
  73. 73.
    Koutourousiou M, Gardner PA, Kofler JK, Fernandez-Miranda JC, Snyderman CH, Lunsford LD (2013) Rare infundibular tumors: clinical presentation, imaging findings, and the role of endoscopic endonasal surgery in their management. J Neurol Surg B Skull Base 74:1–11PubMedGoogle Scholar
  74. 74.
    Ida CM, Yan X, Jentoft ME, Kip NS, Scheithauer BW, Morris JM, Dogan A, Parisi JE, Kovacs K (2013) Pituicytoma with gelsolin amyloid deposition. Endocr Pathol 24:149–155CrossRefPubMedGoogle Scholar
  75. 75.
    Feng M, Carmichael JD, Bonert V, Bannykh S, Mamelak AN (2014) Surgical management of pituicytomas: case series and comprehensive literature review. Pituitary 17:399–413CrossRefPubMedGoogle Scholar
  76. 76.
    Teti C, Castelletti L, Allegretti L, Talco M, Zona G, Minuto F, Boschetti M, Ferone D (2015) Pituitary image: pituicytoma. Pituitary 18:592–597CrossRefPubMedGoogle Scholar
  77. 77.
    Kim YG, Park YS (2015) Second-stage transsphenoidal approach (TSA) for highly vascular pituicytomas in children. Childs Nerv Syst 31:985–989CrossRefPubMedGoogle Scholar
  78. 78.
    Cambiaso P, Amodio D, Procaccini E, Longo D, Galassi S, Camassei FD, Cappa M (2015) Pituicytoma and cushing’s disease in a 7-year-old girl: a mere coincidence? Pediatrics 136:e1632–e1636CrossRefPubMedGoogle Scholar
  79. 79.
    Richer M, Keith J (2016) Coexisting pituicytoma and pituitary adenoma: a second coincidence? Hum Pathol 55:204–205CrossRefPubMedGoogle Scholar
  80. 80.
    Qu L, Zhou Y, Yao W, Wang Y (2015) Pituicytoma: a study of three cases with literature review. Zhonghua Bing Li Xue Za Zhi 44:206–207 (Chinese) PubMedGoogle Scholar
  81. 81.
    Shim HK, Cha SH, Cho WH, Park SH (2017) Pituicytoma with significant tumor vascularity mimicking pituitary macroadenoma. Brain Tumor Res Treat 5:110–115CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Casanueva FF, Barkan AL, Buchfelder M, Kilbanski A, Laws ER, Loeffler JS et al (2017) Criteria for the definition of Pituitary Tumor Centers of Excellence (PTCOE): a pituitary society statement. Pituitary 20:489–498CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2018

Authors and Affiliations

  • F. J. Salge-Arrieta
    • 1
    Email author
  • R. Carrasco-Moro
    • 1
  • V. Rodríguez-Berrocal
    • 1
  • H. Pian
    • 2
  • J. S. Martínez-San Millán
    • 3
  • P. Iglesias
    • 4
  • L. Ley-Urzáiz
    • 1
  1. 1.Department of NeurosurgeryRamón y Cajal University HospitalMadridSpain
  2. 2.Department of NeuropathologyRamón y Cajal University HospitalMadridSpain
  3. 3.Department of NeuroradiologyRamón y Cajal University HospitalMadridSpain
  4. 4.Department of EndocrinologyRamón y Cajal University HospitalMadridSpain

Personalised recommendations