Skip to main content

Advertisement

SpringerLink
Log in

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

  • Endocrine Surgery
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Purpose

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.

Method

Cross-sectional study with retrospective data.

Results

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.

Conclusion

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.

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

Similar content being viewed by others

References

  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. 232−299

  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. 631−641

  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 52−54

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

    Article  PubMed  Google 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

    Article  CAS  PubMed  Google Scholar 

  6. O. Mete, M.B. Lopes, Overview of the 2017 WHO Classification of Pituitary Tumors. Endocr. Pathol. 28, 228–243 (2017). https://doi.org/10.1007/s12022-017-9498-z

    Article  CAS  PubMed  Google Scholar 

  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). https://doi.org/10.3174/ajnr.A2717

    Article  CAS  PubMed  Google Scholar 

  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). https://doi.org/10.1016/j.neurocir.2012.03.001

    Article  PubMed  Google Scholar 

  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). https://doi.org/10.1016/j.patol.2013.05.002

    Article  Google Scholar 

  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)

    Article  CAS  PubMed  Google Scholar 

  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)

    Article  PubMed  Google 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

    Article  PubMed  Google Scholar 

  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). https://doi.org/10.1186/1752-1947-5-64

    Article  Google Scholar 

  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). https://doi.org/10.1097/NEN.0b013e3181a13fca

    Article  CAS  PubMed  Google Scholar 

  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). https://doi.org/10.1007/s12022-013-9279-2

    Article  PubMed  Google 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

    Article  CAS  PubMed  Google Scholar 

  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). https://doi.org/10.1007/s00401-017-1769-8

    Article  CAS  PubMed  Google Scholar 

  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). https://doi.org/10.1016/j.humpath.2008.08.013

    Article  PubMed  Google 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. 329−336

  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). https://doi.org/10.1111/neup.12291

    Article  CAS  PubMed  Google Scholar 

  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)

    Article  PubMed  Google 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

  23. A. Pirayesh Islamian, R. Buslei, W. Saeger, R. Fahlbusch, Pituicitoma: overview of treatment strategies and outcome. Pituitary 15, 227–236 (2012). https://doi.org/10.1007/s11102-011-0317-0

    Article  PubMed  Google Scholar 

  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). https://doi.org/10.3892/mmr.2015.3476

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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)

    Article  CAS  PubMed  Google Scholar 

  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). https://doi.org/10.1080/02688697.2018.1472212

    Article  Google Scholar 

  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). https://doi.org/10.1080/02688697.2018.1464121

    Article  Google Scholar 

  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)

    CAS  PubMed  Google Scholar 

  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). https://doi.org/10.4103/0366-6999.201605

    Article  PubMed  PubMed Central  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 

  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)

    Article  CAS  PubMed  Google Scholar 

  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). https://doi.org/10.1007/s11102-013-0515-z

    Article  PubMed  Google Scholar 

  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)

    Article  CAS  PubMed  Google Scholar 

  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). https://doi.org/10.1016/j.crad.2016.04.022

    Article  CAS  Google Scholar 

  35. R.J. Benveniste, D. Purohit, H. Byun, Pituicytoma presenting with spontaneous hemorrhage. Pituitary 9, 53–58 (2006)

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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). https://doi.org/10.14791/btrt.2015.3.1.60

    Article  PubMed  PubMed Central  Google Scholar 

  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). https://doi.org/10.1007/s11102-016-0704-7

    Article  PubMed  Google Scholar 

  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). https://doi.org/10.1007/s11060-010-0229-2

    Article  PubMed  Google Scholar 

  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). https://doi.org/10.1016/j.jocn.2017.02.017

    Article  PubMed  Google Scholar 

  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). https://doi.org/10.1007/s11102-014-0568-7

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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). https://doi.org/10.1097/MD.0000000000005657

    Article  PubMed  PubMed Central  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

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google 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

    Article  PubMed  Google Scholar 

  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). https://doi.org/10.1007/s11102-010-0262-3

    Article  PubMed  Google Scholar 

  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). https://doi.org/10.1007/s10014-011-0051-3

    Article  PubMed  Google Scholar 

  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)

    Article  CAS  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  51. R.J. Kowalski, R.A. Prayson, M.R. Mayberg, Pituicytoma. Ann. Diagn. Pathol. 8, 290–294 (2004)

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Georgina Petropoulos Nouna for the language review of the paper.

Author information

Authors and Affiliations

  1. Department of Endocrinology, Hospital Universitari de Bellvitge, Barcelona, Spain

    Fernando Guerrero-Pérez, Agustina Pia Marengo & Carles Villabona

  2. Department of Pathology, Hospital Universitari de Bellvitge, Barcelona, Spain

    Noemi Vidal

  3. Department of Endocrinology, Hospital Universitari Mutua Terrassa, Barcelona, Spain

    Carlos Del Pozo

  4. Department of Endocrinology, Hospital Universitario Príncipe de Asturias, Madrid, Spain

    Concepción Blanco

  5. Department of Neurosurgery, Hospital Universitario Miguel Servet, Zaragoza, Spain

    David Rivero-Celada

  6. Department of Endocrinology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain

    Juan José Díez & Pedro Iglesias

  7. Department of Endocrinology, Hospital General Universitario de Alicante, Alicante, Spain

    Antonio Picó

Authors
  1. Fernando Guerrero-Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Noemi Vidal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Agustina Pia Marengo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carlos Del Pozo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Concepción Blanco
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David Rivero-Celada
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Juan José Díez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pedro Iglesias
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antonio Picó
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Carles Villabona
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fernando Guerrero-Pérez.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-018-1774-2

Keywords

Search

Navigation