Posterior Pituitary Tumours: Patient Outcomes and Determinants of Disease Recurrence or Persistence

Overview

Journal Endocr Connect

Specialty Endocrinology

Date 2021 Mar 12

PMID 33709954

Citations 6

Authors

Liza Das

Kim Vaiphei

Ashutosh Rai

Chirag Kamal Ahuja

Paramjeet Singh

Ishani Mohapatra

Rajesh Chhabra

Anil Bhansali

Bishan Dass Radotra

Ashley B Grossman

Marta Korbonits

Pinaki Dutta

Affiliations

Soon will be listed here.

Abstract

Objective: Posterior pituitary tumours (PPTs) are rare neoplasms with the four recognised subtypes unified by thyroid transcription factor -1 (TTF-1) expression, according to the 2017 WHO classification. Though traditionally defined as low-grade neoplasms, a substantial proportion of them show recurrence/persistence following surgery.

Methods: We selected patients with PPTs in our cohort of 1760 patients operated for pituitary tumours over the past 10 years (2010-2019). The clinical, radiological, hormonal, histopathological profiles and long-term outcomes of the three cases identified (two pituicytomas and one spindle cell oncocytoma, SCO) were analysed. Following a literature review, data of all published cases with documented TTF-1 positive pituicytomas and SCOs were analysed to determine the predictors of recurrence/persistence in these tumours.

Results: Patients presented with compressive features or hypogonadism. Two had sellar-suprasellar masses. One had a purely suprasellar mass with a pre-operative radiological suspicion of pituicytoma. Two were operated by transsphenoidal surgery and one transcranially guided by neuronavigation. Histopathology confirmed spindle cells in a storiform arrangement and low Ki67 index. Immunohistochemistry showed positive TTF-1, S-100 expression and variable positivity for EMA, vimentin and GFAP. Re-evaluation showed recurrence/persistence in two patients. A literature review of recurrent/persistent pituicytoma (n = 17) and SCO (n = 9) cases revealed clinical clues (headache for pituicytomas, male gender for SCO), baseline tumour size (≥20.5 mm with sensitivity exceeding 80%) and longer follow-up duration as determinants of recurrence/persistence.

Conclusion: PPTs are rare sellar masses with quintessential TTF-1 positivity. Recurrent/persistent disease following surgery is determined by greater tumour size at baseline and duration of follow-up. This warrants intensive and long-term surveillance in these patients.

Citing Articles

Posterior pituitary tumors and other rare entities involving the pituitary gland.

Roncaroli F, Giannini C Brain Pathol. 2024; 35(1):e13307.

PMID: 39350562 PMC: 11669417. DOI: 10.1111/bpa.13307.

Intraventricular pituicytoma: illustrative case.

Hanyu T, Ishibashi R, Kitamura K, Nishida N, Yuba Y, Honjo G J Neurosurg Case Lessons. 2024; 8(9).

PMID: 39186831 PMC: 11373697. DOI: 10.3171/CASE24247.

Treatment modalities and outcomes of granular cell tumors and spindle cell oncocytomas of the pituitary gland: an analysis of two national cancer databases.

Alexander A, Michalopoulos G, Kerezoudis P, Van Gompel J, Link M, Peris-Celda M Acta Neurochir (Wien). 2024; 166(1):169.

PMID: 38578465 DOI: 10.1007/s00701-024-06054-6.

Spindle cell oncocytoma of the pituitary tumor: A rare case report and literature reviews.

Chang C, Shen C Front Surg. 2023; 9:1021680.

PMID: 36793516 PMC: 9923168. DOI: 10.3389/fsurg.2022.1021680.

The Diagnostic Impact of Epigenomics in Pituicyte-derived Tumors: Report of an Unusual Sellar Lesion with Extensive Hemorrhage and Necrotic Debris.

Dottermusch M, Rotermund R, Ricklefs F, Wefers A, Saeger W, Flitsch J Endocr Pathol. 2022; 33(3):411-413.

PMID: 35921032 PMC: 9420089. DOI: 10.1007/s12022-022-09727-z.

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