ENDOSCOPIC ENDONASAL REMOVAL OF PITUICYTOMAS AND SPINDLE CELL ONCOCYTOMAS

Introduction. Pituicytomas and spindle cell oncocytomas (SCO) are very rare benign tumors of sellar and suprasellar region (grade I). In case of these tumors, the clinical symptoms and the results of neuroimaging are not specific, so it is almost impossible to diagnose the pituicytoma or SCO preoperatively. The feature of these tumors is ample blood supply which results in intense intraoperative bleeding. Such events on background of high density and infiltrative growth of the tumors make a radical resection difficult.

Objective is to present our own experience in surgical treatment and perioperative management of 8 SCO and 5 pituicytomas and compare it with the data of the scientific literature.

Materials and methods. The retrospective study included 8 patients with SCO and 5 patients with pituicytomas that underwent endoscopic endonasal transsphenoidal removal in 2012–2017. Also, the literature data on pituicytoma and SCO were analyzed.

Results. Total resection of SCO was successful in 4 cases, subtotal resection was done in 2 cases, and partial resection was done in 2 cases. All pituicytomas were resected extensively. Relapse of SCO was found in 4 patients. Postoperative complications (visual disorders and hemorrhagic complications) occurred in 2 SCO patients and in 1 pituicytoma patient. Postoperative improvement was seen in 3 patients.

Conclusion. Optimal treatment method for pituicytoma and SCO of sellar and suprasellar region is a total resection using endoscopic endonasal access. The prognosis is favorable if the resection was total, however, if the resection was not extensive a relapse of the tumor can occur, and repeated operation or radiation therapy can be required. In case of slow asymptomatic progression of the tumor, an observation can be continued.

1. Zygourakis C.C., Rolston J.D., Lee H.S. et al. Pituicytomas and spindle cell oncocytomas: modern case series from the University of California, San Francisco. Pituitary 2015;18(1):150–8. DOI: 10.1007/s11102-014-0568-7. PMID: 24823438.

2. Louis D.N., Ohgaki H., Wiestler O.D. et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007;114(2):97–109. DOI: 10.1007/s00401-007-0243-4.

3. Shah B., Lipper M.H., Laws E.R. et al. Posterior pituitary astrocytoma: a rare tumor of the neurohypophysis: a case report. AJNR Am J Neuroradiol 2005;26(7):1858–61. PMID: 16091544.

4. Brat D.J., Scheithauer B.W., Staugaitis S.M. et al. Pituicytoma: a distinctive low grade glioma of the neurohypophysis. Am J Surg Pathol 2000;24(3):362–8. DOI: 10.1097/00000478-200003000-00004. PMID: 10716149.

5. Roncaroli F., Scheithauer B.W., Cenacchi G. et al. “Spindle cell oncocytoma” of the adenohypophysis: a tumor of folliculostellate cells? Am J Surg Pathol 2002;26(8):1048–55. DOI: 10.1097/00000478-200208000-00010. PMID: 12170092.

6. Vajtai I., Sahli R., Kappeler A. Spindle cell oncocytoma of the adenohypophysis: report of a case with a 16-year follow-up. Pathol Res Pract 2006;202(10):745–50. DOI: 10.1016/j.prp.2006.05.008. PMID: 16884858.

7. Wang J., Liu Z., Du J. et al. The clinicopathological features of pituicytoma and the differential diagnosis of sellar glioma. Neuropathology 2016;36(5):432–40. DOI: 10.1111/neup.12291.

8. Nakasu Y., Nakasu S., Saito A. et al. Pituicytoma. Two case reports. Neurol Med Chir (Tokyo) 2006;46(3):152–6. DOI: 10.2176/nmc.46.152.

9. Furtado S.V., Ghosal N., Venkatesh P.K. et al. Diagnostic and clinical implications of pituicytoma. J Clin Neurosci 2010;17(7):938–43. DOI: 10.1016/j.jocn.2009.09.047.

10. Orrego J.J. Pituicytoma and isolated ACTH deficiency. Pituitary 2009;12:371–2. DOI: 10.1007/s11102-009-0185-z.

11. Phillips J.J., Misra A., Feuerstein B.G. et al. Pituicytoma: characterization of a unique neoplasm by histology, immunohistochemistry, ultrastructure, and array-based comparative genomic hybridization. Arch Pathol Lab Med 2010;134(7):1063–9. DOI: 10.1043/2009-0167-CR.1.

12. Wolfe S.Q., Bruce J., Morcos J.J. Pituicytoma: case report. Neurosurgery 2008;63:173–4. DOI: 10.1227/01.neu.0000335084.93093.c8.

13. Singh G., Agarwal S., Sharma M.C. et al. Spindle cell oncocytoma of the adenohypophysis: Report of a rare case and review of the literature. Clin Neurol Neurosurg 2012;114:267–71. DOI: 10.1016/j.clineuro.2011.10.014.

14. Oertel J., Gaab M.R., Linsler S. The endoscopic endonasal transsphenoidal approach to sellar lesions allows a high radicality: the benefit of angled optics. Clin Neurol Neurosurg 2016;146:29–34. DOI: 10.1016/j.clineuro.2016.04.016.

15. Louis R.G., Eisenberg A., Barkhoudarian G. et al. Evolution of minimally invasive approaches to the sella and parasellar region. Int Arch Otorhinolaryngol 2014;18(Suppl 2):S136–48. DOI: 10.1055/s-0034-1395265.

16. Oertel J., Gaab M.R., Tschan C.A., Linsler S. Mononostril endoscopic transsphenoidal approach to sellar and peri-sellar lesions: personal experience and literature review. Br J Neurosurg 2015;29(4):532–7. DOI: 10.3109/02688697.2015.1014997.

17. Aydin S., Cavallo L.M., Messina A. et al. The endoscopic endonasal transsphenoidal approach to the sellar and suprasellar area. Anatomic study. J Neurosurg Sci 2007;51(3):129–38. PMID: 17641577.

18. Takei Y., Seyama S., Pearl G.S., Tindall G.T. Ultrastructural study of the human neurohypophysis cellular elements of neural parenchyma, the pituicytes. Cell Tissue Res 1980;205(2): 273–87. DOI: 10.1007/bf00234685.

19. Liss L. Pituicytoma, a tumor of the hypothalamus; clinicopathological report of a case. AMA Arch Neurol Psychiatry 1958;80(5):567–76. DOI: 10.1001/archneurpsyc. 1958.02340110037005.

20. Liss L., Kahn E.A. Pituicytoma, tumor of the sella turcica; a clinicopathological study. J Neurosurg 1958;15(5):481–8. DOI: 10.3171/jns.1958.15.5.0481. PMID: 13576191.

21. Massie A.P. A granular-cell pituicytoma of the neurohypophysis. J Pathol 1979;129(2):53–6. DOI: 10.1002/path.1711290202.

22. Cusick J.F., Ho K.C., Hagen T.C., Kun L.E. Granular-cell pituicytoma associated with multiple endocrine neoplasia type. J Neurosurg 1982;56(4):594–6. DOI: 10.3171/jns.1982.56.4.0594.

23. Becker D.H., Wilson C.B. Symptomatic parasellar granular cell tumors. Neurosurgery 1981;8(2):173–80. DOI: 10.1097/00006123-198102000-00006.

24. Rossi M.L., Bevan J.S., Esiri M.M. et al. Pituicytoma (pilocytic astrocytoma). Case report. J Neurosurg 1987;67(5):768–72. DOI: 10.3171/jns.1987.67.5.0768.

25. 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. DOI: 10.1080/019131201753136331.

26. Lee E.B., Tihan T., Scheithauer B.W. et al. Thyroid transcription factor 1 expression in sellar tumors: a histo-genetic marker? J Neuropathol Exp Neurol 2009;68(5):482–8. DOI: 10.1097/nen.0b013e3181a13fca.

27. Saeed Kamil Z., Sinson G., Gucer H. et al. TTF-1 expressing sellar neoplasm with ependymal rosettes and oncocytic change: mixed ependymal and oncocytic variant pituicytoma. Endocr Pathol 2014;25(4):436–8. DOI: 10.1007/s12022-013-9279-2.

28. Zunarelli E., Casaretta G.L., Rusev B., Lupi M. Pituicytoma with atypical histological features: are they predictive of unfavourable clinical course? Pathology 2011;43:389–93. DOI: 10.1097/pat.0b013e32834687b3.

29. Zhi L., Yang L., Quan H., Bai-ning L. Pituicytoma presenting with atypical histological features. Pathology 2009;41:505–9. DOI: 10.1080/00313020903041119.

30. Matyja E., Maksymowicz M., Grajkowska W. et al. Spindle cell oncocytoma of the adenohypophysis – a clinicopathological and ultrastructural study of two cases. Folia Neuropathol 2010;48(3):175–84. PMID: 20925001.

31. Covington M.F., Chin S.S., Osborn A.G. Pituicytoma, spindle cell oncocytoma, and granular cell tumor: clarification and meta-analysis of the world literature since 1893. AJNR Am J Neuroradiol 2011;32(11):2067–72. DOI: 10.3174/ajnr.a2717.

32. Fujisawa H., Tohma Y., Muramatsu N. et al. Spindle cell oncocytoma of the adenohypophysis with marked hypervascularity. Case report. Neurol Med Chir (Tokyo) 2012;52(8):594–8. DOI: 10.2176/nmc.52.594.

33. Mu Q., Yu J., Qu L. et al. Spindle cell oncocytoma of the adenohypophysis: two case reports and a review of the literature. Mol Med Rep 2015;12(1):871–6. DOI: 10.3892/mmr.2015.3476.

34. Dahiya S., Sarkar C., Hedley-Whyte E.T. Spindle cell oncocytoma of the adenohypophysis: report of two cases. Acta Neuropathol 2005;110(1):97–9. DOI: 10.1007/s00401-005-1009-5.

35. Romero-Rojas A.E., Melo-Uribe M.A., Barajas-Solano P.A. et al. Spindle cell oncocytoma of the adenohypophysis. Brain Tumor Pathol 2011;28(4):359e64. DOI: 10.1007/s10014-011-0051-3.

36. Rotman J.A., Kucharczyk W., Zadeh G. et al. Spindle cell oncocytoma of the adenohypophysis: a case report illustrating its natural history with 8-year observation and a review of the literature. Clin Imaging 2014;38(4):499–504. DOI: 10.1016/j.clinimag.2014.03.003.

37. Farooq M.U., Bhatt A., Chang H.T. Teaching neuroimage: spindle cell oncocytoma of the pituitary gland. Neurology 2008;71(2):e3. DOI: 10.1212/ 01.wnl.0000316805.30694.4f.

38. Ogiwara H., Dubner S., Shafizadeh S. et al. Spindle cell oncocytoma of the pituitary and pituicytoma: two tumors mimicking pituitary adenoma. Surg Neurol Int 2011;2:116. DOI: 10.4103/2152-7806.83932.

39. Kloub O., Perry A., Tu P.H. et al. Spindle cell oncocytoma of the adenohypophysis: report of two recurrent cases. Am J Surg Pathol 2005;29(2):247e53. DOI: 10.1097/01.pas.0000147400.87767.f6.

40. Mlika M., Azouz H., Chelly I. et al. Spindle cell oncocytoma of the adenohypophysis in a woman: a case report and review of the literature. J Med Case Rep 2011;5:64. DOI: 10.1186/1752-1947-5-64.

41. Vuong H.G., Kondo T., Tran T.M. et al. Spindle cell oncocytoma of adenohypophysis. Report of a case and immunohistochemical review of literature. Pathol Res Pract 2016;212(3):222–5. DOI: 10.1016/j.prp.2015.07.014.

42. Scheithauer B.W., Kowacs K., Horvath E. et al. Pathology of the pituitary and sellar region. In: Practical surgical neuropathology, a diagnostic approach. Ed. by A. Perry, D.J. Brat. Chirchill Livingstone Elsevier, 2010. 402 p.

43. Baloch Z.W., LiVolsi V.A. Oncocytic lesions of the neuroendocrine system. Semin Diagn Pathol 1999:16:190–9.

44. Guadagno E., Cervasio M., Di Somma A. et al. Essential role of ultrastructural examination for spindle cell oncocytoma: case report of a rare neoplasm and review of the literature. Ultrastruct Pathol 2016;40(2):121–4. DOI: 10.3109/01913123.2016.1157662.

45. Mete O., Lopes M.B., Asa S.L. Spindle cell oncocytomas and granular cell tumors of the pituitary are variants of pituicytoma. Am J Surg Pathol 2013;37(11):1694–9. DOI: 10.1097/pas.0b013e31829723e7.

46. Yoshimoto T., Takahashi-Fujigasaki J., Inoshita N. et al. TTF-1-positive oncocytic sellar tumor with follicle formation/ependymal differentiation: non-adenomatous tumor capable of two different interpretations as a pituicytoma or a spindle cell oncocytoma. Brain Tumor Pathol 2015;32(3):221–7. DOI: 10.1007/s10014-015-0219-3.

47. Chakraborti S., Mahadevan A., Govindan A. et al. Pituicytoma: report of three cases with review of literature. Pathol Res Pract 2013;209(1):52–8. DOI: 10.1016/j.prp.2012.10.006.

48. Hammoud D.A., Munter F.M., Brat D.J., Pomper M.G. Magnetic resonance imaging features of pituicytomas: analysis of 10 cases. J Comput Assist Tomogr 2010;34:757–61. DOI: 10.1097/rct.0b013e3181e289c0.

49. Zhang F., Chen J., You C. Pituicytoma: case report and review of the literature. Neurol India 2010;58(5):799–801. DOI: 10.4103/0028-3886.72187.

50. Secci F., Merciadri P., Criminelli Rossi D. et al. Pituicytomas: radiological findings, clinical behavior and surgical management. Acta Neurochir (Wien) 2012;154(4):649–57. DOI: 10.1007/s00701-011-1235-7.