Skip to main content

Advertisement

SpringerLink
Log in

Granular cell tumors of the sellar region: what should be done after subtotal resection? A systematic review

  • Published:
Pituitary Aims and scope Submit manuscript

Abstract

Purpose

Granular cell tumors (GCT) are highly vascularized and adherent to adjacent structures, and so, complete resection represents a challenge. Adjuvant therapy decisions for residual GCTs currently relies on individual clinician decisions due to a paucity of systematic literature data. We present a comprehensive analysis about the impact of adjuvant therapy in reported cases of patients with incomplete GCT resection.

Methods

One database (PubMed) and crossed references were queried for GCT with incomplete resection or biopsy from 1962 to 2020. Literature review was performed according to the PRISMA guidelines. Also, two patients with residual GCT from our institutions are added to the analysis. Data regarding clinical presentation, surgical approach, use of adjuvant therapy, Ki-67 labeling, and follow up assessments were extracted and analyzed from selected publications.

Results

Thirty-three studies met the predetermined inclusion criteria and 53 patients were selected (including our two reported cases). The median of age was 49 [IQR, 39–60 years], with a slight male predominance (1.2:1). Among the surgical procedures, seven (13%) were biopsies alone. Adjuvant therapy was used in 18 patients (radiotherapy, 94.5%; chemotherapy, 5.5%) but there is no statistical correlation with adjuvant therapy and the progression of the remnant tumor (p = 0.33). Our institutions’ patients did not receive adjuvant therapy and did not show tumor progression on MRI.

Conclusion

Our systematic literature review suggests there is a limited role for chemo and/or radiotherapy in the management of incomplete GCT resection. It may be reasonable recommending close clinical follow up in patients with incomplete resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

GCT:

Granular cell tumor

STR:

Subtotal resection

PR:

Partial resection

MRI:

Magnetic resonance imaging

CT:

Computed tomography

GTR:

Gross total resection

RT:

Radiotherapy

CTX:

Chemotherapy

CFU:

Close follow up

WHO:

World Health Organization

References

  1. Boyce R, Beadles CF (1893) A further contribution to the study of the pathology of the hypophysis cerebri. J Pathol Bacteriol 1:359–383

    Article  Google Scholar 

  2. Glazer N, Hauser H, Slade H (1956) Granular cell tumor of the neurohypophysis. Am J Roentgenol Radium Ther Nucl Med. https://doi.org/10.1007/978-3-7091-8420-2_8

    Article  PubMed  Google Scholar 

  3. Luse SA, Kernohan JW (1955) Granular-cell tumors of the stalk and posterior lobe of the pituitary gland. Cancer 8:616–622

    Article  CAS  Google Scholar 

  4. DeLellis RA (2004) Pathology and genetics of tumours of endocrine organs. IARC, Lyon

    Google Scholar 

  5. 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. https://doi.org/10.1097/PAS.0b013e31829723e7

    Article  PubMed  Google Scholar 

  6. Lopes MBS (2017) The 2017 World Health Organization classification of tumors of the pituitary gland: a summary. Acta Neuropathol 134:521–535

    Article  CAS  Google Scholar 

  7. Louis DN, Perry A, Reifenberger G et al (2016) The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 131:803–820

    Article  Google Scholar 

  8. Orning JL, Trembath DG, Zanation AM, Germanwala AV (2013) Endoscopic endonasal approach for resection of infundibular granular cell tumor: case report and literature review. J Case Rep Med. https://doi.org/10.4303/jcrm/235775

    Article  PubMed  PubMed Central  Google Scholar 

  9. Famini P, Maya MM, Melmed S (2011) Pituitary magnetic resonance imaging for sellar and parasellar masses: ten-year experience in 2598 patients. J Clin Endocrinol Metab. https://doi.org/10.1210/jc.2011-0168

    Article  PubMed  PubMed Central  Google Scholar 

  10. Han F, Gao L, Wang Y et al (2018) Clinical and imaging features of granular cell tumor of the neurohypophysis. Medicine (United States). https://doi.org/10.1097/MD.0000000000009745

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tomita T, Gates E (1999) Pituitary adenomas and granular cell tumors: Incidence, cell type, and location of tumor in 100 pituitary glands at autopsy. Am J Clin Pathol. https://doi.org/10.1093/ajcp/111.6.817

    Article  PubMed  Google Scholar 

  12. Liwnicz BH, Liwnicz BH, Liwnicz RG et al (1984) Giant granular cell tumor of the suprasellar area; immunocytochemical and electron microscopic studies. Neurosurgery 15:246–251

    Article  CAS  Google Scholar 

  13. Gibbs WN, Monuki ES, Linskey ME, Hasso AN (2006) Pituicytoma: diagnostic features on selective carotid angiography and MR imaging. Am J Neuroradiol 24:1639–1642

    Google Scholar 

  14. Zhang Y, Teng Y, Zhu H et al (2018) Granular cell tumor of the neurohypophysis: 3 cases and a systematic literature review of 98 cases. World Neurosurg 118:e621–e630

    Article  Google Scholar 

  15. Cone L, Srinivasan M, Romanul FC (1990) Granular cell tumor (choristoma) of the neurohypophysis: two cases and a review of the literature. Am J Neuroradiol 11:403–406

    CAS  PubMed  Google Scholar 

  16. Melmed S (2020) Pituitary-tumor endocrinopathies. N Engl J Med 382:937–950

    Article  CAS  Google Scholar 

  17. Gagliardi F, Losa M, Boari N et al (2013) Suprasellar granular cell tumor of the neurohypophysis in a child: unusual presentation in pediatric age of a rare tumor. Child’s Nerv Syst 29:1031–1034

    Article  Google Scholar 

  18. Faramand A, Kano H, Flickinger JC et al (2018) A Case of symptomatic granular cell tumor of the pituitary treated with stereotactic radiosurgery. Stereotact Funct Neurosurg 96:1–7

    Article  Google Scholar 

  19. Schaller B, Kirsch E, Tolnay M, Mindermann T (1998) Symptomatic granular cell tumor of the pituitary gland: case report and review of the literature. Neurosurgery. https://doi.org/10.1097/00006123-199801000-00036

    Article  PubMed  Google Scholar 

  20. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. https://doi.org/10.1016/j.jclinepi.2009.06.005

    Article  PubMed  Google Scholar 

  21. Koutourousiou M, Gardner PA, Kofler JK et al (2013) Rare infundibular tumors: clinical presentation, imaging findings, and the role of endoscopic endonasal surgery in their management. J Neurol Surgery B 74:1–11. https://doi.org/10.1055/s-0032-1329619

    Article  Google Scholar 

  22. Saint-Blancard P, Pierre B, Philippe C, de Soultrait FR (2007) Une cause rare de diminution de l’acuité visuelle : la tumeur à cellules granuleuses neurohypophysaire. Neurochirurgie 53:296–298. https://doi.org/10.1016/j.neuchi.2007.05.004

    Article  CAS  PubMed  Google Scholar 

  23. Kobayashi TK, Bamba M, Oka H et al (2006) Granular cell tumour of the neurohypophysis on cytological squash preparations. Cytopathology 17:153–154

    Article  CAS  Google Scholar 

  24. Nishio S, Takeshita I, Yoshimoto K, Yamaguchi T (1998) Granular cell tumor of the pituitary stalk. Clin Neurol Neurosurg. https://doi.org/10.1016/S0303-8467(98)00017-1

    Article  PubMed  Google Scholar 

  25. Higuchi M, Tsuji M, Iked HA (1997) Sym ptom atic hypophyseal granular cell tum our: endocrinological and clinicopathological analysis. Br J Neurosurg 11:582–586

    Article  CAS  Google Scholar 

  26. Bello CT, Cipriano P, Henriques V et al (2018) Granular cell tumour of the neurohypophysis: an unusual cause of hypopituitarism. Endocrinol Diabetes Metab Case Rep. https://doi.org/10.1530/edm-17-0178

    Article  PubMed  PubMed Central  Google Scholar 

  27. Friede RL, Yasargil MG (1977) Suprasellar neoplasm with a granular cell component. J Neuropathol Exp Neurol. https://doi.org/10.1097/00005072-197709000-00001

    Article  PubMed  Google Scholar 

  28. Liu HL, Huang BY, Zhang MS et al (2017) Sellar and suprasellar granular cell tumor of neurohypophysis. Chin Med J (Engl) 130:741–743. https://doi.org/10.4103/0366-6999.201605

    Article  Google Scholar 

  29. Freda PU, Beckers AM, Katznelson L et al (2011) Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. https://doi.org/10.1210/jc.2010-1048

    Article  PubMed  PubMed Central  Google Scholar 

  30. Freda PU, Wardlaw SL (1999) Clinical review 110: diagnosis and treatment of pituitary tumors. J Clin Endocrinol Metab 84:3859–3866

    Article  CAS  Google Scholar 

  31. Cohen-Gadol AA, Pichelmann MA, Link MJ et al (2003) Granular cell tumor of the sellar and suprasellar region: clinicopathologic study of 11 cases and literature review. Mayo clinic proceedings. Elsevier, Amsterdam, pp 567–573

    Google Scholar 

  32. Ahmed AK, Dawood HY, Cote DJ et al (2019) Surgical resection of granular cell tumor of the sellar region: three indications. Pituitary. https://doi.org/10.1007/s11102-019-00999-z

    Article  PubMed  Google Scholar 

  33. Feng Z, Mao Z, Wang Z et al (2018) Non-adenomatous pituitary tumours mimicking functioning pituitary adenomas. Br J Neurosurg. https://doi.org/10.1080/02688697.2018.1464121

    Article  PubMed  Google Scholar 

  34. Shuangshoti S, Navalitloha Y, Shuangshoti S et al (1998) Atypical granular cell tumor of the neurohypophysis: a case report with review of the literature. J Med Assoc Thail 81:641–646

    CAS  Google Scholar 

  35. Becker DH, Wilson CB (1981) Symptomatic parasellar granular cell tumors. Neurosurgery 8:173–179. https://doi.org/10.1227/00006123-198102000-00006

    Article  CAS  PubMed  Google Scholar 

  36. Guerrero-Pérez F, Vidal N, Marengo AP et al (2019) Posterior pituitary tumours: the spectrum of a unique entity. A clinical and histological study of a large case series. Endocrine 63:36–43. https://doi.org/10.1007/s12020-018-1774-2

    Article  CAS  PubMed  Google Scholar 

  37. Kasashima S, Oda Y, Nozaki JI et al (2000) A case of atypical granular cell tumor of the neurohypophysis. Pathol Int 50:568–573. https://doi.org/10.1046/j.1440-1827.2000.01080.x

    Article  CAS  PubMed  Google Scholar 

  38. Doron Y, Behar A, Beller AJ (1965) Granular-cell “myoblastoma” of the neurohypophysis. J Neurosurg 22:95–99. https://doi.org/10.3171/jns.1965.22.1.0095

    Article  CAS  PubMed  Google Scholar 

  39. Menon G, Easwer HV, Radhakrishnan VV, Nair S (2008) Symptomatic granular cell tumour of the pituitary. Br J Neurosurg 22:126–130. https://doi.org/10.1080/02688690701604566

    Article  CAS  PubMed  Google Scholar 

  40. Fazekas JT (1977) Treatment of grades I and II brain astrocytomas. The role of radiotherapy. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/0360-3016(77)90045-1

    Article  PubMed  Google Scholar 

  41. Stieber VW, Mehta MP (2007) Advances in radiation therapy for brain tumors. Neurol Clin 25:1005–1033

    Article  Google Scholar 

  42. Al-Mefty O, Kersh JE, Routh A, Smith RR (1990) The long-term side effects of radiation therapy for benign brain tumors in adults. J Neurosurg. https://doi.org/10.3171/jns.1990.73.4.0502

    Article  PubMed  Google Scholar 

  43. Surma-Aho O, Niemelä M, Vilkki J et al (2001) Adverse long-term effects of brain radiotherapy in adult low-grade glioma patients. Neurology. https://doi.org/10.1212/WNL.56.10.1285

    Article  PubMed  Google Scholar 

  44. Donahue B (1992) Short- and long-term complications of radiation therapy for pediatric brain tumors. Pediatr Neurosurg 18:207–217

    Article  CAS  Google Scholar 

  45. Rim CH, Yang DS, Park YJ et al (2011) Radiotherapy for pituitary adenomas: long-term outcome and complications. Radiat Oncol J. https://doi.org/10.3857/roj.2011.29.3.156

    Article  PubMed  PubMed Central  Google Scholar 

  46. Jang JW, Chan AW (2013) Prevention and management of complications after radiotherapy for skull base tumors: a multidisciplinary approach. Adv Otorhinolaryngol. https://doi.org/10.1159/000342293

    Article  PubMed  Google Scholar 

  47. Cook B, Withrow LA, Spencer SA et al (2004) Radiation tolerance of the optic apparatus. Int J Radiat Oncol. https://doi.org/10.1016/j.ijrobp.2004.07.289

    Article  Google Scholar 

  48. Burston J, John R, Spencer H (1962) Myoblastoma ” of the neurohypophysis. J Pathol Bacteriol 83:455–461

    Article  CAS  Google Scholar 

  49. Moriyama E, Matsumoto Y, Meguro T, Mano S (1996) Suprasellar granular cell tumor: case report. Neurol Med Chir (Tokyo) 36:237–240. https://doi.org/10.2176/nmc.36.237

    Article  CAS  Google Scholar 

  50. Ogata S, Shimazaki H, Aida S et al (2001) Giant intracranial granular-cell tumor arising from the abducens. Pathol Int 51:481–486. https://doi.org/10.1046/j.1440-1827.2001.01229.x

    Article  CAS  PubMed  Google Scholar 

  51. Rhee JS, Wackym PA, Hague K et al (2002) Granular cell tumor of the pituitary fossa. Ann Otol Rhinol Laryngol. https://doi.org/10.1177/000348940211100818

    Article  PubMed  Google Scholar 

  52. Lee CC, Liu CH, Wei CP, How SW (2004) Symptomatic granular cell tumor of the neurohypophysis. J Formos Med Assoc 103:58–62

    PubMed  Google Scholar 

  53. Aquilina K, Kamel M, Kalimuthu SG et al (2006) Granular cell tumour of the neurohypophysis: a rare sellar tumour with specific radiological and operative features. Br J Neurosurg 20:51–54. https://doi.org/10.1080/02688690600600996

    Article  CAS  PubMed  Google Scholar 

  54. Shizukuishi T, Abe O, Haradome H et al (2014) Granular cell tumor of the neurohypophysis with optic tract edema. Jpn J Radiol 32:179–182. https://doi.org/10.1007/s11604-013-0279-4

    Article  PubMed  Google Scholar 

  55. Lettau M, Munk R (2014) Granularzelltumor des Infundibulums. RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgeb Verfahren 186:805–806. https://doi.org/10.1055/s-0033-1356188

    Article  CAS  Google Scholar 

  56. Gregoire A, Bosschaert P, Godfraind C (2015) Granular cell tumor of the pituitary stalk: a rare and benign entity. J Belg Soc Radiol 99:79–81. https://doi.org/10.5334/jbr-btr.841

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Li P, Yang Z, Wang Z et al (2016) Granular cell tumors in the central nervous system: a report on eight cases and a literature review. Br J Neurosurg 30:611–618. https://doi.org/10.1080/02688697.2016.1181152

    Article  PubMed  Google Scholar 

  58. Gagliardi F, Spina A, Barzaghi LR et al (2016) Suprasellar granular cell tumor of the neurohypophysis: surgical outcome of a very rare tumor. Pituitary. https://doi.org/10.1007/s11102-016-0704-7

    Article  PubMed  Google Scholar 

  59. Thakkar K, Ramteke-Jadhav S, Kasaliwal R et al (2020) Sellar surprises: a single-centre experience of unusual sellar masses. Endocr Connect. https://doi.org/10.1530/EC-19-0497

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the meaningful contributions of Jose Otero, MD, PhD (Pathology Department, Ohio State University), who provided the pathological slides and helped with the histology description.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Hospital Nacional Posadas, Buenos Aires, Argentina

    Franco Rubino, Daniel Seclen Voscoboinik & Miguel Mural

  2. Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, N-1049 Doan Hall, Columbus, OH, 43210, USA

    Rafael Martinez-Perez, Samuel Vieira, Anna J. Orr, Douglas A. Hardesty, Ricardo L. Carrau & Daniel M. Prevedello

  3. Department of Otolaryngology Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Douglas A. Hardesty, Ricardo L. Carrau & Daniel M. Prevedello

Authors
  1. Franco Rubino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rafael Martinez-Perez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samuel Vieira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Seclen Voscoboinik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Miguel Mural
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anna J. Orr
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Douglas A. Hardesty
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ricardo L. Carrau
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Daniel M. Prevedello
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel M. Prevedello.

Ethics declarations

Conflict of interest

Daniel M. Prevedello is a consultant for Integra LifeSciences Corp, Stryker Corporation and Medtronic Corp. Daniel Prevedello has equity on 3 rivers LLC, eLUM Technologies, LLC and Soliton LLC. Daniel Prevedello receives royalties from KLS-Martin, ACE Medical and Mizuho.

Informed consent

To participate, prior informed consent from the patients was obtained. Data collection was performed under the protocols of the Human Research Protection Office of both institutions.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rubino, F., Martinez-Perez, R., Vieira, S. et al. Granular cell tumors of the sellar region: what should be done after subtotal resection? A systematic review. Pituitary 23, 721–732 (2020). https://doi.org/10.1007/s11102-020-01068-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11102-020-01068-6

Keywords

Search

Navigation