Treatment and prognostic factors of pituicytoma: a single-center experience and comprehensive literature review

Posterior pituitary tumors: an entity unto itself

Posterior pituitary tumors (PPT) are rare, benign tumors but may lead to compromised hypothalamic and pituitary function. A new study by Kremenevski et al. presents a single institution experience of these tumors, namely, pituicytomas, spindle cell oncocytomas, and granular cell tumors. They incorporate the revised 2022 WHO classification and highlight the preoperative and postoperative endocrine, metabolic, and radiologic outcomes of PPT. This study adds to our knowledge in this rare subset of tumors and underscores the need for ongoing surveillance for hypopituitarism and hypothalamic obesity.

A Rare Case of Pituicytoma During Pregnancy

Pituicytomas are rare benign sellar tumors that originate in the neurohypophysis. We report the first case of a pituicytoma during pregnancy, causing headaches and bilateral temporal visual field defects. A 32-year-old woman at 16 weeks of gestation was admitted to our hospital for headaches and progressively worsening visual impairment. Cranial magnetic resonance imaging (MRI) revealed a sellar lesion that was resected via a neuroendoscopic endonasal-transsphenoid approach. Pathology revealed a pituicytoma with positive progesterone receptor expression. After cerebrospinal fluid (CSF) leakage repair and anti-infective therapy, the patient recovered well and finally gave birth to a healthy child. This is the first case of pituicytoma during pregnancy reported. Pregnancy may have a contributing effect on the progression of progesterone receptor-positive pituicytomas. Surgical intervention, when performed with appropriate perioperative management, can effectively alleviate mass effects caused by pituicytomas in pregnant women while maintaining the safety of the fetus.

Preoperative Prediction of Non-functional Pituitary Neuroendocrine Tumors and Posterior Pituitary Tumors Based on MRI Radiomic Features

Compared to non-functional pituitary neuroendocrine tumors (NF-PitNETs), posterior pituitary tumors (PPTs) require more intraoperative protection of the pituitary stalk and hypothalamus, and their perioperative management is more complex than NF-PitNETs. However, they are difficult to be distinguished via magnetic resonance images (MRI) before operation. Based on clinical features and radiological signature extracted from MRI, this study aims to establish a model for distinguishing NF-PitNETs and PPTs. Preoperative MRI of 110 patients with NF-PitNETs and 55 patients with PPTs were retrospectively obtained. Patients were randomly assigned to the training (n = 110) and validation (n = 55) cohorts in a 2:1 ratio. The lest absolute shrinkage and selection operator (LASSO) algorithm was applied to develop a radiomic signature. Afterwards, an individualized predictive model (nomogram) incorporating radiomic signatures and predictive clinical features was developed. The nomogram's performance was evaluated by calibration and decision curve analyses. Five features derived from contrast-enhanced images were selected using the LASSO algorithm. Based on the mentioned methods, the calculation formula of radiomic score was obtained. The constructed nomogram incorporating radiomic signature and predictive clinical features showed a good calibration and outperformed the clinical features for predicting NF-PitNETs and PPTs (area under the curve [AUC]: 0.937 vs. 0.595 in training cohort [p < 0.001]; 0.907 vs. 0.782 in validation cohort [p = 0.03]). The decision curve shows that the individualized predictive model adds more benefit than clinical feature when the threshold probability ranges from 10 to 100%. Individualized predictive model provides a novel noninvasive imaging biomarker and could be conveniently used to distinguish NF-PitNETs and PPTs, which provides a significant reference for preoperative preparation and intraoperative decision-making.

Clinical, surgical, and endocrine outcome following treatment of posterior pituitary tumors: a retrospective cohort study

PURPOSE

This study evaluates the clinical presentation, endocrine dysfunction, surgical outcome, and long-term prognosis in patients with histologically confirmed posterior pituitary tumors (PPTs).

METHODS

A retrospective cohort study was conducted on 19 patients treated for PPTs at a single center between 2000 and 2023. Data on clinical, endocrine, and surgical outcomes were collected and analyzed.

RESULTS

The cohort included 3 pituicytomas (PCs), 8 granular cell tumors (GCTs), and 8 spindle cell oncocytomas (SCOs) patients, with a female predominance (58%) and a mean age of 57.2 ± 13.2 years. Symptoms leading to diagnosis were headache (31.6%), visual impairment (21%), and sexual dysfunction (10.5%). GCT patients had higher preoperative BMI (34.49 ± 5.72) compared to PC (22.12 ± 2.40) and SCO (24.74 ± 4.24) patients (p < 0.01). Postoperative BMI increased across all groups, with GCTs patients showing the steepest rise (p < 0.01). Endocrine dysfunction largely persisted or worsened after surgery, with limited recovery at follow-up. Surgical approaches included transsphenoidal (48%) and transcranial (52%), achieving gross total resection in 58% of cases. Tumor recurrence occurred in 16% of patients, all requiring adjuvant radiation therapy. Tumor-specific survival at 5 years was 100% with an overall survival rate of 80% where non-tumor-related comorbidities accounted for the observed mortality.

CONCLUSION

PPTs are rare tumors with significant endocrine and metabolic consequences. While surgical management is associated with favorable tumor-specific survival, persistent endocrine dysfunction and postoperative progressive BMI underscore the need for long-term follow-up and targeted interventions. These findings contribute to the understanding of PPT biology and support the development of optimized management strategies.

Posterior transpetrosal approach to a suprasellar retroinfundibular pituicytoma: A case report and comprehensive literature review

Introduction

Pituicytomas are rare benign glial neoplasms (WHO grade I) located in the sellar or suprasellar regions, arising from the neurohypophysis and infundibular area. They typically present with symptoms due to the slow growth of the tumor, including hormonal changes, visual impairment, and headaches.

Research question

This case report evaluates the effectiveness of the posterior transpetrosal approach for the resection of a retroinfundibular suprasellar pituicytoma, focusing on preserving pituitary function and minimizing surgical risks.

Material and methods

We present a 59-year-old female with a pituicytoma diagnosed by MRI and digital subtraction angiography (DSA). Preoperative embolization was performed to reduce the tumor's vascularity. The patient underwent a left posterior transpetrosal approach for tumor resection, with key surgical steps focusing on preserving the pituitary stalk, optic chiasm, and perforating vessels.

Results

The posterior transpetrosal approach provided excellent exposure, enabling near-total resection of the tumor. The patient had no new neurological deficits postoperatively, and follow-up MRI at 6 months showed no tumor recurrence.

Discussion and conclusion

This case demonstrates the safety and efficacy of the posterior transpetrosal approach for pituicytoma resection. The approach allowed for optimal visualization and preservation of critical structures, particularly the pituitary stalk, leading to a favorable clinical outcome. Our findings, supported by a literature review, suggest that this technique is a valuable option for tumors in retroinfundibular and suprasellar locations.

Intraventricular pituicytoma: illustrative case

BACKGROUND

Pituicytoma is a rare glial neoplasm from pituicytes of the neurohypophysis or infundibulum. It occurs in the sella and suprasellar area, and it is extremely uncommon to observe intraventricular pituicytoma without affecting the infundibulum or infundibular recess.

OBSERVATIONS

A 69-year-old man had suffered progressive dementia for 6 months. Magnetic resonance imaging revealed a solid, homogeneously enhancing mass with flow voids within the anterior third ventricle. The sella, suprasellar area, infundibulum, and infundibular recess were unaffected. The patient underwent a transcallosal transchoroidal approach, which ended in partial removal of the tumor due to significant tumoral bleeding. A second surgery resulted in its subtotal removal. The tumor had bipolar cells, and their nuclei were immunoreactive for thyroid transcription factor-1. A DNA methylation analysis corresponded to the methylation class of pituicytoma, granular cell tumor, and spindle cell oncocytoma. Pituicytoma was the diagnosis based on these results. A systematic review identified 5 intraventricular pituicytoma cases.

LESSONS

Intraventricular pituicytoma can grow without involvement of the infundibulum or infundibular recess. The current case suggests that pituicytes of the hypothalamic tuber cinereum can also give rise to pituicytoma. Because of the hypervascular nature of intraventricular pituicytomas, it is imperative to control intraoperative bleeding with attention to the adjacent hypothalamus. https://thejns.org/doi/10.3171/CASE24247.

Preoperatively Predicting Ki67 Expression in Pituitary Adenomas Using Deep Segmentation Network and Radiomics Analysis Based on Multiparameter MRI

RATIONALE AND OBJECTIVES

Ki67 proliferation index is associated with more aggressive tumor behavior and recurrence of pituitary adenomas (PAs). Recently, radiomics and deep learning have been introduced into the study of pituitary tumors. The present study aimed to investigate the feasibility of predicting the Ki67 proliferation index of PAs using the deep segmentation network and radiomics analysis based on multiparameter MRI.

MATERIALS AND METHODS

First, the cfVB-Net autosegmentation model was trained; subsequently, its performance was evaluated in terms of the dice similarity coefficient (DSC). In the present study, 1214 patients were classified into the high Ki67 expression group (HG) and the low Ki67 expression group (LG). Analyses of three classification models based on radiomics features were performed to distinguish HG from LG. Clinical factors, imaging features, and Radscores were collectively used to create a nomogram in order to effectively predict Ki67 expression.

RESULTS

The cfVB-Net segmentation model demonstrated good performance (DSC: 0.723-0.930). Overall, 18, 15, and 11 optimal features in contrast-enhanced (CE) T1WI, T1WI, and T2WI were obtained for differentiating between HG and LG, respectively. Notably, the best results were presented in the bagging decision tree when CE T1WI and T1WI were combined (area under the receiver operating characteristic curve: training set, 0.927; validation set, 0.831; and independent testing set, 0.825). In the nomogram, age, Hardy' grade, and Radscores were identified as risk predictors of high Ki67 expression.

CONCLUSION

The deep segmentation network and radiomics analysis based on multiparameter MRI exhibited good performance and clinical application value in predicting the expression of Ki67 in PAs.

Surgical approach to the treatment of pituicytoma. Report of five cases and a literature review

Background

Pituicytoma (PTs) is a rare tumor of the sella and suprasellar region, derived from the pituicytes of the neurohypophysis, having distinct histological characteristics of glial neoplasms. We reported, the clinical data, neuroimaging studies, surgical approaches and pathology in five patients with PTs and also, we reviewed the literature.

Methods

Retrospective chart from five consecutive patients with PTs treated at one University Hospital from 2016 to 2021 were reviewed. In addition, we conducted a search in PubMed/Medline databases using the term "Pituicytoma". Data regarding age, gender, pathological findings, and treatment modality applied were extracted.

Results

All patients were female, aged 29-63, complaining of headaches, visual loss and field defects, dizziness and normal or abnormal levels of circulating pituitary hormones. Magnetic Resonance Imaging (MRI) showed in all patients a sellar and suprasellar mass, which was removed through an endoscopic transsphenoidal approach. Our third patient had a subtotal resection followed by close observation. Histopathology showed a glial non-infiltrative tumors with spindle cells, and a final diagnosis of pituicytoma was made. After surgery, visual field defects in all patients were normalized, and in two patients normal levels of plasma hormones were restored. After a mean of three years follow-up, the patients were managed post-operatively through close clinical observation and serial MRI. None of the patients had recurrence of the disease.

Conclusion

PTs is a rare glial tumor of the sellar and suprasellar region that arises from neurohypophyseal pituicytes. Disease control may be achieved by total excision.

Pituicytoma: A rare tumor of the sella. A case report and review of literature for diagnosis and management

Background

Pituicytomas are rare tumors of the pituitary gland derived from the ependymal cells and line the pituitary stalk and posterior lobe. These tumors are located in the vulnerable regions of the brain: Either in the sellar or suprasellar area. The location marks the difference in the clinical features of the tumor. Here, we report a case of histopathologically diagnosed pituicytoma of the sellar region. Literature is also reviewed and discussed to gain a better understanding of this rare disease.

Case Description

A 24-year-old female presented to the outpatient department with complaints of headache, diplopia, dizziness, and decreased vision in the right eye for 6 months. Computed tomography scan brain without contrast showed a well-defined hyperdense lesion in the sella without associated bony erosion. Her magnetic resonance imaging showed well defined rounded lesion in the pituitary fossa which was isointense on T1-weighted image and hyperintense on T2-weighted images. A presumptive diagnosis of pituitary adenoma was made. She underwent endoscopic endonasal transsphenoidal resection of pituitary mass. Intraoperatively, normal pituitary gland was visualized and there was a grayish-green-colored, jelly like tumor which was pulled gently. On 9^th postoperative day, she presented with cerebrospinal fluid (CSF) rhinorrhea. She underwent endoscopic CSF leak repair. Her histopathology was concluded to be Pituicytoma.

Conclusion

Pituicytoma is an uncommon diagnosis. The surgical aim is to completely excise the tumor which results in complete cure, but incomplete resection may be performed due to high vascularity of this tumor. In case of incomplete excision, recurrence is common and adjuvant radiotherapy may be administered.

Pituicytoma: A rare case report of sellar and suprasellar tumor

Introduction

Pituicytomas are low-grade glial tumors in the sellar and suprasellar region. They may be easily confused with pituitary lesions. We review the literature in order to better understand and categorize the natural history, clinical presentations, and treatments.

Presentation of case

A 45-year-old female patient who complained of left eye blurred vision for 2 months. The imaging study revealed a solid sellar tumor with marked homogeneous enhancement following intravenous administration of gadolinium, and compression of the optic chiasm. Thus, under the preoperative diagnosis of pituitary macroadenoma, the patient underwent endoscope-assisted surgery via the transsphenoidal approach. The patient recovered well after surgery. The histopathological diagnosis was pituicytoma, WHO grade I.

Clinical discussion

Pituicytomas are defined as a circumscribed low-grade glial tumor arising from the neurohypophysis or infundibulum with bipolar spindle cells arranged in a fascicular or storiform pattern (a cartwheel). The clinical symptoms are variable depending on the tumor size and location. They usually present due to mass effect. The radiographic characteristics are not nonspecific. The diagnosis of pituicytoma is based on histopathological evidence. Pituicytomas consist of a solid proliferation of elongated spindle cells arranged in interlacing fascicles and/or in a “storiform” pattern. In immunohistochemical studies, pituicytomas was strongly expressed in TTF-1.

Conclusion

Pituicytomas are benign, slow-growing glial tumors. It is difficult to diagnosed before operation as its clinical presentations and imaging studies resemble those of non-functional pituitary adenomas. The best chance of successful treatment is gross total resection by the endoscopic approach or transcranial approach.

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Pituicytomas are rare benign tumors arising from the neurohypophysis or infundibulum.

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They are often mistaken for pituitary adenomas which have a similar clinical presentations and imaging findings.

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The diagnosis of pituicytoma is based on histopathological evidence. In immunohistochemical studies, pituicytomas was strongly expressed in TTF-1.

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Complete resection of the tumor is the main treatment for pituicytoma. The choice of surgical route used may depended on the tumor size, whether invasion to other structures has occurred, and the technique of the surgeon.

Pituicytoma Associated with Suspected Cushing’s Disease: Two Case Reports and a Literature Review

(1) Background: Pituicytomas are rare gliomas located in the neurohypophysis or infundibulum. A misdiagnosis of pituicytoma as pituitary adenoma is common because of similar location and occasional endocrine disturbances. (2) Case presentation: We present two cases with the comorbidity of pituicytoma and Cushing’s disease (CD). Case 1 is that of a 51-year-old woman, the first reported case of the comorbidity of pituicytoma, CD, and central diabetes insipidus. She received a diagnosis of CD and central diabetes insipidus. After transsphenoidal surgery, histopathology confirmed the diagnosis of pituicytoma and adrenocorticotropin-secreting microadenoma; case 2 is that of a 29-year-old man who received a biochemical diagnosis of CD, but he received a histopathological confirmation of only pituicytoma. Both patients achieved a remission of hypercortisolism without relapse during the follow-up, but they developed hypopituitarism after surgery. We also reviewed all published 18 cases with the comorbidity of pituicytoma and any pituitary adenoma. (3) Conclusions: Pituicytoma might present pituitary hyperfunction disorders such as CD or acromegaly, with or without pathologically confirmed pituitary adenoma. CD is the most common hyperpituitarism occurring concurrently with pituicytomas. The remission rate and hypopituitarism after surgery seem similar or slightly lower in CD than in common pituitary adenomas, but the long-term prognosis is unexplored.

Surgical management of pituicytomas: a single-center case series

OBJECTIVE

Pituicytomas (PT) are rare benign sellar and/or supra sellar tumors which surgical treatment might be challenging, owing to the hypervascularity of the tumor. Here, we report our experience with PTs, describe their clinical and radiological features, and propose an optimal therapeutic strategy.

METHODS

This is a retrospective single-center study, reporting the clinical manifestations, radiological characteristics, histopathological features, treatment strategies and long-term outcomes of four patients who have been treated for a PT at Bicêtre University Hospital in Paris, France, over the past 7 years.

RESULTS

Four patients were operated mean age at presentation was 60.25 years. Main symptoms, which tended to be progressive, included visual field defects and pituitary-hypothalamic dysfunction. Radiologically, all our cases resented with sellar and suprasellar localization with cavernous invasion in 75% of cases. Endoscopic transphenoidal approach was performed as first surgery for all cases. Transcranial route was done in one case. During surgery, important bleeding was observed in all cases. Gross total resection was obtained with a single surgery in two cases and a second surgery was necessary in the two remaining cases. Pathological diagnosis was confirmed in all cases. No recurrences were noted after an average follow-up of 3.6 years.

CONCLUSIONS

PT is a rare differential diagnosis of sellar and/or parasellar tumors, whose hemorrhagic nature can become a challenge during surgery. We added four more cases to the literature to make physicians establish Piticytomas at suspicion diagnosis for sellar and/or suprasellar masses. Knowing the diagnosis, a preparation should be made preoperatively to avoid possible complications peroperatively.