Surgical management of pituicytomas: a single-center case series

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.

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

BACKGROUND

Spindle cell oncocytomas (SCO) and granular cell tumors (GCT) are rare primary pituitary neoplasms; the optimal treatment paradigms for these lesions are unknown and largely unexplored. Thus, using national registries, we analyze the epidemiology, management patterns, and surgical outcomes of SCOs and GCTs.

METHODS

The National Cancer Database (NCDB; years 2003-2017) and the Surveillance, Epidemiology, and End Results Program (SEER; years 2004-2018) were queried for patients with pituitary SCOs or GCTs. Incidence, extent of surgical resection, and rate of postoperative radiation use for subtotally resected lesions comprised the primary outcomes of interest. All-cause mortality was also analyzed via time-to-event Kaplan-Meier curves.

RESULTS

SCOs and GCTs have an annual incidence of 0.017 and 0.023 per 1,000,000, respectively. They comprise 0.1% of the benign pituitary tumors registered in NCDB. A total of 112,241 benign pituitary tumors were identified in NCDB during the study period, of which 83 (0.07%) were SCOs and 59 (0.05%) were GCTs. Median age at diagnosis was 55 years, 44% were females, and median maximal tumor diameter at presentation was 2.1 cm. Gross total resection was achieved in 54% patients. Ten patients (7%) had postoperative radiation. Comparing patients with GCTs versus SCOs, the former were more likely to be younger at diagnosis (48.0 vs. 59.0, respectively; p < 0.01) and female (59% vs. 34%, p = 0.01). GCTs and SCOs did not differ in terms of size at diagnoses (median maximal diameter: 1.9 cm vs. 2.2 cm, respectively; p = 0.59) or gross total resection rates (62% vs. 49%, p = 0.32). After matching SCOs and GCTs with pituitary adenomas on age, sex, and tumor size, the former were less likely to undergo gross total resection (53% vs. 72%; p = 0.03). Patients with SCOs and GCTs had a shorter overall survival when compared to patients with pituitary adenomas (p < 0.01) and a higher rate of thirty-day mortality (3.1% vs 0.0%; p = 0.013).

CONCLUSION

SCOs and GCTs are rare pituitary tumors, and their management entails particular challenges. Gross total resection is often not possible, and adjuvant radiation might be employed following subtotal resection.