- Department of Neurosurgery, Santa Casa Hospital, Faculty of Medical Science of Minas Gerais, Belo Horizonte, Brazil
Rafael Augusto Castro Santiago Brandão
Department of Neurosurgery, Santa Casa Hospital, Faculty of Medical Science of Minas Gerais, Belo Horizonte, Brazil
DOI:10.4103/2152-7806.73802© 2010 Brandóo RACS This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Rafael Augusto Castro Santiago Brandão, Vieira Braga MH, de Souza AA, Baltazar Leão Reis, Reis BL. Pituicytoma. Surg Neurol Int 13-Dec-2010;1:79
How to cite this URL: Rafael Augusto Castro Santiago Brandão, Vieira Braga MH, de Souza AA, Baltazar Leão Reis, Reis BL. Pituicytoma. Surg Neurol Int 13-Dec-2010;1:79. Available from: http://sni.wpengine.com/surgicalint_articles/pituicytoma/
Background:Pituicytomas originate from pituicytes, modified glial cells derived from ependymal lineage that are found in the stalk and posterior lobe of pituitary gland. The clinical presentation is similar to other pituitary tumors and imaging exams may suggest pituitary adenoma. The diagnostic is based on histopathological analysis. Surgical treatment can be performed by transsphenoidal approach with good results. The prognostic is good after total tumor resection.
Case Description:We describe here the case of a 17-year-old patient with a history of persistent headache and visual disturbances. Magnetic resonance imaging demonstrated an enhancing solid sellar mass suggestive of pituitary adenoma. The intrasellar mass was resected through a transsphenoidal approach and the diagnosis of pituicytoma was made after histopathological analysis.
Conclusion:Pituicytomas are rare tumors of the neurohypophysis derived from pituicytes. Their clinical presentation resembles that of non-functional pituitary adenomas, but these two types of tumors are histologically well distinct.
Keywords: Glioma, hypophysis, neurohypophyseal tumor, pituicytes, pituicytoma, pituitary gland, pituitary tumors
Pituicytomas are very rare primary tumors of the neurohypophysis and can affect both the sellar and suprasellar regions. Few cases have been described in the literature.[
Pituicytomas originate from pituicytes, modified glial cells derived from ependymal lineage which are found in the stalk and posterior lobe of pituitary gland.[
Clinical presentation: A 17-year-old boy was reported with a history of persistent headache and recent onset of visual disturbances. Examination revealed bitemporal heteronymous hemianopsia and swelling of the left optic papilla. The remaining neurological exam was normal. Magnetic resonance imaging (MRI) of the brain revealed a contrast-enhancing, expansive solid sellar and suprasellar mass with an intermediate signal intensity on T1- and T2-weighted images, measuring about 2.6 cm × 1.6 cm × 1.5 cm [
Surgery: The patient was submitted to partial transphenoidal resection of the tumor. The surgical aspect did not differ from that found in a pituitary adenoma, both in consistency, color, as well as in bleeding. The cavity was filled with autologous fat.
Postoperative period: The patient presented no major complications, except for diabetes insipidus detected during the early postoperative period which was completely controlled. Residual tumor was identified, but no tumor recurrence was observed after a follow-up period of 24 months.
Pathological anatomy: Microscopy showed a predominantly fusocellular tumor consisting of pleomorphic cells with a fascicular growth pattern. The cells were characterized by abundant eosinophilic cytoplasm, vesiculous nucleo with mild atipia and clearly visible nucleoli. Mitotic figures were occasionally observed [
The material was analyzed by immunohistochemical study. Antibodies against several antigens were tested and are shown in
The neurohypophysis comprises the posterior portion of the pituitary, infundibulum, and tuber cinerium.[
The most common pituitary tumors are adenomas originating from the adenohypophysis. Although rare, posterior pituitary tumors include hamartomas, craniopharyngiomas, germinomas, granular cell tumors, meningiomas, pituicytomas, and pilocytic astrocytomas.[
Few cases of primary tumors of the neurohypophysis have been described, a fact impairing the classification of these tumors. So far, 30 cases of pituicytomas have been published [
Pituicytomas are rare, noninfiltrative tumors of glial origin, which arise in the neurohypophysis that comprises the posterior region of the pituitary and the pituitary stalk.[
Histologically, pituicytomas are characterized by spindle-shaped cells arranged in interlacing fascicles. Nuclei is oval to elongated with a mild irregularity. The citoplasm is eosinophilic and homogeneous which presents little or no granulation or vacuolization and necrosis is absent.[
The most common clinical presentation was headache and bitemporal hemianopsia due to compression of the optic chiasm.[
No tumor recurrence was observed in the related case after a follow-up period of 24 months. Although few studies are available in the literature, data suggest a high rate of tumor recurrence after partial resection and a good prognosis, with little or no recurrence, after total resection.[
Pituicytomas are rare tumors of the neurohypophysis derived from pituicytes. Their clinical presentation resembles that of non-functional pituitary adenomas, but these two types of tumors are histologically well distinct. Surgery is the indicated treatment with a good prognosis if the tumor is completely resected.
1. Benveniste RJ, Purohit D, Byun H. Pituicytoma presenting with spontaneous hemorrhage. Pituitary. 2006. 9: 53-8
2. Brat DJ, Scheithauer BW, Staugaitis SM, Holtzman RN, Morgello S, Burer PC. Pituicytoma: A distinctive low-grade glioma of the neurohypophysis. Am J Surg Pathol. 2000. 24: 362-8
3. Cenacchi G, Giovenali P, Castrioto C, Giangaspero F. Pituicytoma: Ultrastructural evidence of a possible origin from folliculo-stellate cells of the adenohypophysis. Ultrastruct Pathol. 2001. 25: 309-12
4. Chen KT. Crush cytology of pituicytoma. Diagn Cytopathol. 2005. 33: 255-7
5. Figarella-Branger D, Dufour H, Fernandez C, Bouvier-Labit C, Grisoli F, Pellissier JF. Pituicytomas, a mis-diagnosed benign tumor of the neurohypophysis: Report of three cases. Acta Neuropathol. 2002. 104: 313-9
6. Gibbs WN, Monuki ES, Linskey ME, Hasso AN. Pituicytoma: Diagnostic features on selective carotid angiography and MR imaging. AJNR Am J Neuroradiol. 2006. 27: 1639-42
7. Hurley TR, D’Angelo CM, Clasen RA, Wilkinson SB, Passavoy RD. Magnetic resonance imaging and pathological analysis of a pituicytoma: Case report. Neurosurgery. 1994. 35: 314-7
8. Katsuta T, Inoue T, Nakagaki H, Takeshita M, Morimoto K, Iwaki T. Distinctions between pituicytoma and ordinary pilocytic astrocytoma. J Neurosurg. 2003. 98: 404-6
9. Kowalski RJ, Prayson RA, Mayberg MR. Pituicytoma. Ann Diagn Pathol. 2004. 8: 290-4
10. Liss L. The cellular elements of the neurohypophysis. J Comp Neurol. 1956. 106: 507-25
11. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007. 114: 97-109
12. Nakasu Y, Nakasu S, Saito A, Horiguchi S, Kameya T. Pituicytoma. Two case reports. Neurol Med Chir (Tokyo). 2006. 46: 152-6
13. Nishizawa S, Yokoyama T, Hinokuma K, Ohta S, Uemura K, Takahashi H. Pituitary astrocytoma: Magnetic resonance and hormonal characteristics. J Neurosur. 1997. 87: 131-
14. Orrego JJ. Pituicytoma and isolated ACTH deficiency. Pituitary. 2009. 12: 371-2
15. Scheithauer BW, Horvath E, Kovacs K. Ultrastructure of neurohypophysis. Microscop Res Tech. 1992. 20: 177-86
16. Schultz AB, Brat DJ, Oyesiku NM, Hunter SB. Intrasellar pituicytoma in a patient with other endocrine neoplasms. Arch Pathol Lab Med. 2001. 125: 527-30
17. Shah B, Lipper MH, Laws ER, Lopes MB, Spellman MJ. Posterior pituitary astrocytoma: A rare tumor of neurohypophysis: A Case Report. AJNR Am J Neuroradiol. 2005. 26: 1858-61
18. Takei Y, Seyama S, Pearl GS, Tindall GT. Ultrastructural study of the human neurohypophysis cellular elements of neural parenchyma, the pituicytes. Cell Tissue Res. 1980. 205: 273-87
19. Thiryayi WA, Gnanalingham KK, Reid H, Heald A, Kearney T. Pituicytoma: A misdiagnosed benign tumour of the posterior pituitary. Br J Neurosurg. 2007. 21: 47-8
20. Uesaka T, Miyazono M, Nishio S, Iwaki T. Astrocytoma of the pituitary gland (pituicytoma): Case report. Neuroradiology. 2002. 44: 123-5
21. Ulm AJ, Yachnis AT, Brat DJ, Rhoton AL. Pituicytoma: Report of two cases and clues regarding histogenesis. Neurosurgery. 2004. 54: 753-7
22. Wolfe SQ, Bruce J, Morcos JJ. Pituicytoma: Case Report. Neurosugery. 2008. 63: E173-4