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LETTER TO EDITOR  
Year : 2013  |  Volume : 56  |  Issue : 2  |  Page : 180-181
Pituicytoma: A case report with literature revisited


1 Department of Pathology, TN Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
2 Consultant Histopathologist, Centre of Excellence, Histopathology, SRL Diagnostics, Mumbai, Maharashtra, India

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Date of Web Publication23-Sep-2013
 

How to cite this article:
Shenoy AS, Desai HM, Mehta JK. Pituicytoma: A case report with literature revisited. Indian J Pathol Microbiol 2013;56:180-1

How to cite this URL:
Shenoy AS, Desai HM, Mehta JK. Pituicytoma: A case report with literature revisited. Indian J Pathol Microbiol [serial online] 2013 [cited 2020 Jul 16];56:180-1. Available from: http://www.ijpmonline.org/text.asp?2013/56/2/180/118695


Sir,

Pituicytoma is a rare glial sellar/suprasellar neoplasm arising in the neurohypophysis with a possible origin from the folliculo-stellate cells of the adenohypophysis. [1] We report here a case of a suprasellar pituicytoma arising in a 28-year-old female.

A 28-year-old female came with the complaints of progressively increasing headaches and visual disturbances in the form of decreased vision in the left eye since 2 months. Magnetic resonance imaging (MRI) showed a 4.2 cm × 3.5 cm × 2.7 cm well-defined strongly enhancing space occupying lesion in suprasellar location [Figure 1]. The pre-operative diagnosis was pituitary adenoma. Prolactin levels were 24.5 ng/ml (Normal values: 5.18-26.53 ng/ml). The tumor was completely excised through a trans-sphenoidal approach.
Figure 1: Magnetic resonance imaging scan showing a 4.2 cm × 3.5 cm × 2.7 cm well-defined space occupying lesion in the suprasellar region, which was strongly contrast enhancing (post-contrast)

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Histology showed a tumor composed of spindled cells in fascicles with oval to elongated nuclei and moderate amount of eosinophilic, non-granular cytoplasm [Figure 2] with a differential diagnosis of meningioma, pituicytoma, spindle cell oncocytoma (SCO) and hemangiopericytoma.
Figure 2: Tumor seen arranged in whorls and fascicles with moderate amount of eosinophilic, non-granular cytoplasm and prominent blood vessels

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Immunohistochemical (IHC) profile of tumor cells revealed diffuse positivity for vimentin, S-100, thyroid transcription factor-1 (TTF-1) and Bcl-2 [Figure 3] and negativity for Epithelial membrane antigen (EMA), CD-34, glial fibrillary acidic protein (GFAP) and synaptophysin [Figure 4] with 1% Mib-1 proliferative index. The histopathological diagnosis was of a suprasellar pituicytoma. The post-operative course was uneventful. However, the patient was lost to follow-up.
Figure 3: Immunohistochemical stains showing diffuse positivity for vimentin (cytoplasmic), S-100 (nuclear and cytoplasmic), thyroid transcription factor-1 (nuclear) and Bcl-2 (cytoplasmic)

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Figure 4: Negativity for EMA, CD-34, GFAP and synaptophysin immunohistochemical stains

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Pituicytoma is considered to be a distinct Grade I neoplasm according to the World Health Organization 2007 classification of central nervous system tumors. [2] Less than 50 cases have been reported in the world literature till date.

The histogenesis is still debated with recent reports suggesting that pituicytomas arise from the folliculo-stellate cells of the adenohypophysis which are non-endocrine spindled cells expressing S-100 and Bcl-2. [1] Our case showed strong and diffuse cytoplasmic Bcl-2 positivity suggesting probable origin of pituicytoma from folliculo-stellate cells.

Although usually intra-sellar, pituicytomas can have suprasellar extension; however, purely suprasellar examples although rare have been reported. [3]

Pituicytomas are more common in adult males. The presenting symptoms are due to the mass effect of the tumor and include visual disturbances caused by direct compression on the optic chiasm, headaches, endocrinological symptoms and rarely diabetes insipidus. [4]

The MRI features are non-specific with most case reports showing a solid, homogenous mass, iso-intense on T1-weighted images and hyper-intense on T2-weighted images with homogenous contrast enhancement. [4]

Amongst the various sellar tumors, pituicytoma and SCO have considerable overlap in histological, IHC profile and can have extensive intraoperative bleeding making complete excision difficult with increased chances of recurrence. It is important to differentiate pituicytoma from SCO since the former is associated with a slightly better prognosis with recurrence being uncommon after complete surgical excision. Till date, out of 29 cases of pituicytoma with a detailed follow-up, recurrence was seen in six cases, all of which were found to have an incomplete resection during the first surgery. [5] SCO on the other hand have a tendency to recur even after complete excision. Hence, it is advocated to combine surgery with adjuvant radiotherapy in all cases of SCO to reduce the chances of recurrence. EMA is strongly positive in SCO, thus it can help to differentiate pituicytoma from SCO. [5]

We report this case because it presented with a supra-sellar mass, an unusual location for pituicytoma with spindled cells in whorls, which was difficult to diagnose on routine neuroimaging and histopathology. Furthermore, pituicytoma is a rare entity since less than 50 cases have been reported in literature so far. We believe that pituicytoma should always be considered in the differential diagnosis of a suprasellar mass in an adult.

 
   References Top

1.Phillips JJ, Misra A, Feuerstein BG, Kunwar S, Tihan T. Pituicytoma: Characterization of a unique neoplasm by histology, immunohistochemistry, ultrastructure, and array-based comparative genomic hybridization. Arch Pathol Lab Med 2010;134:1063-9.  Back to cited text no. 1
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2.Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007;114:97-109.  Back to cited text no. 2
[PUBMED]    
3.Zhang F, Chen J, You C. Pituicytoma: Case report and review of the literature. Neurol India 2010;58:799-801.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Chu J, Yang Z, Meng Q, Yang J. Pituicytoma: Case report and literature review. Br J Radiol 2011;84:e55-7.  Back to cited text no. 4
[PUBMED]    
5.Ogiwara H, Dubner S, Shafizadeh S, Raizer J, Chandler JP. Spindle cell oncocytoma of the pituitary and pituicytoma: Two tumors mimicking pituitary adenoma. Surg Neurol Int 2011;2:116.  Back to cited text no. 5
[PUBMED]  Medknow Journal  

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Correspondence Address:
Heena M Desai
Department of Pathology, TN Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.118695

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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