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LETTER TO EDITOR
Year : 2010  |  Volume : 58  |  Issue : 5  |  Page : 799-801

Pituicytoma: Case report and review of the literature


Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, China

Date of Acceptance14-Jul-2010
Date of Web Publication28-Oct-2010

Correspondence Address:
Chao You
Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.72187

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How to cite this article:
Zhang F, Chen J, You C. Pituicytoma: Case report and review of the literature. Neurol India 2010;58:799-801

How to cite this URL:
Zhang F, Chen J, You C. Pituicytoma: Case report and review of the literature. Neurol India [serial online] 2010 [cited 2019 Sep 19];58:799-801. Available from: http://www.neurologyindia.com/text.asp?2010/58/5/799/72187


Sir,

Pituicytoma is a rare primary glioma of the neurohypophysis. We describe a case of pituicytoma misdiagnosed as craniopharyngioma preoperatively.

A 53-year-old man presented with decreased visual acuity and visual field defect in the right eye of 7 months' duration [Figure 1]a and decreased libido of 2 years' duration. Hormonal profile revealed low serum testosterone level and a prolactin level of 1.73_ng/mL. Contrast magnetic resonance imaging (MRI) showed a solid, homogeneously enhancing suprasellar mass compressing the optic chiasm [Figure 2]a-d and the tumor measured 2.0×1.8×2.0 cm. With a preoperative diagnosis of craniopharyngioma patient underwent craniotomy and partial resection of the tumor because of uncontrollable bleeding. The tumor was soft and brittle. The biopsy revealed multiple lobules of elongated or plump spindle-shaped cells with slightly fibrillar cytoplasm arranged in interlacing fascicles or storiform configurations [Figure 3]a. The cytoplasm was mildly eosinophilic. On immunohistochemistry MIB-1 labeling index was 1%. The tumor cells were strongly immunoreactive for S-100 protein [Figure 3]b and vimentin, focally reactive for glial fibrillary acidic protein (GFAP) [Figure 3]c, especially in the vicinity of blood vessels. The tumor cells showed negative reaction for epithelial membrane antigen (EMA) [Figure 3]d, progesterone receptors, neurofilament protein, P53 and synaptophysin. Periodic acid-Schiff (PAS) stains with or without diastase were negative.
Figure 1 :(a) Visual field deficit before surgery. (b) Postoperatively, the patient suffered more severe visual defects. (c) Improved postoperative visual fields after radiotherapy

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Figure 2 :MRI scans revealing a uniformly enhancing suprasellar mass elevating the optic chiasm. (a) T1-weighted MRI scan with contrast (coronal view), preoperative. (b-d) Axial, sagittal and coronal T1-weighted MRI scans with contrast 1 month after subtotal tumor resection. The chiasm is still compressed

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Figure 3 :(a) Section showing multiple lobules of elongated or plump spindle-shaped cells with slightly fibrillar cytoplasm arranged in interlacing fascicles or storiform configurations. (b-c) Immunohistochemistry studies showing strong, diffuse immunoreactivity for S-100, characteristic of a pituicytoma (b) and immunoreactivity for GFAP (c) but negative for EMA (d) (original magnifications, ×400)

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Postoperatively the patient had worsening in visual acuity in the right eye with ptosis [Figure 1]b and absent libido. He had also decreased visual acuity in the left eye. The patient underwent gamma knife (GK) radiosurgery two months after undergoing a partial resection. The tumor was covered with 50% isodose volume administered at 8 target points using two 8-mm and six 4-mm collimators. A central dose of 24 Gy was used to obtain a marginal dose of 12 Gy. We carefully avoided damage to the optic nerve during the procedure. Follow-up MRI showed reduction of the residual lesion over the course of 13 months [Figure 4]a-d. The patient's visual field defect was alleviated [Figure 1]c.
Figure 4 :(a) T1-weighted MRI scan without contrast after radiotherapy (axial view). (b-d) Pituicytomas are uniformly contrast-enhancing after administration of gadolinium. Axial (b), sagittal (c) and coronal (d) contrast-enhanced MRI scans after radiotherapy. The chiasm is partly decompressed

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Pituicytoma is highly vascular. [1],[2],[3],[4],[5] Probably this character of the tumor was responsible for the massive hemorrhage during operation. Because of this we could not achieve near toral resection of the tumor. Radiation therapy [6] is recommended in patients with subtotal resection, in an effort to control residual tumor and thus increase the survival. Till date only three patients with partial resection had received postoperative radiation. [3],[7],[8] This case report suggests that fractionated stereotactic radiotherapy may be a viable option in controlling tumor remnants if complete resection cannot be achieved. Pituicytoma is a benign, slow-growing tumor and thus cure can be achieved with total resection of the tumor. However, if during operation massive bleed occurs we advocate judicious surgical removal with possible postoperative radiation therapy. This is especially so when the residual tumor is growing.

 
 » References Top

1.Katsuta T, Inoue T, Nakagaki H, Takeshita M, Morimoto K, Iwaki T. Distinctions between pituicytoma and ordinary pilocytic astrocytoma: Case report. J Neurosurg 2003;98:404-6.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Uesaka T, Miyazono M, Nishio S, Iwaki T. Astrocytoma of the pituitary gland (pituicytoma): Case report. Neuroradiology 2002;44:1235.  Back to cited text no. 2
    
3.Ulm AJ, Yachnis AT, Brat DJ, Rhoton AL Jr. Pituicytoma: Report of two cases and clues regarding histogenesis. Neurosurgery 2004;54:753-8.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Benveniste RJ, Purohit D, Byun H. Pituicytoma presenting with spontaneous hemorrhage. Pituitary 2006;9:53-8.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.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.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Schaller B, Kirsch E, Tolnay M, Mindermann T. Symptomatic granular cell tumor of the pituitary gland: Case report and review of the literature. Neurosurgery 1998;42:166-71.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Hurley T, D'Angelo C, Clasen R, Wilkinson S, Passavoy R. Magnetic resonance imaging and pathological analysis of a pituicytoma: Case report. Neurosurgery 1994;35:314-7.  Back to cited text no. 7
    
8.Kowalski RJ, Prayson RA, Mayberg MR. Pituicytoma. Ann Diagn Pathol 2004;8:290-4.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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