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LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 6  |  Page : 678-679

Sellar solitary fibrous tumor mimicking pituitary adenoma


Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China

Date of Submission16-Oct-2012
Date of Decision17-Oct-2012
Date of Acceptance19-Nov-2012
Date of Web Publication29-Dec-2012

Correspondence Address:
Shu Jiang
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.105224

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How to cite this article:
Wu Q, Zhou P, Zhong C, Jiang S. Sellar solitary fibrous tumor mimicking pituitary adenoma . Neurol India 2012;60:678-9

How to cite this URL:
Wu Q, Zhou P, Zhong C, Jiang S. Sellar solitary fibrous tumor mimicking pituitary adenoma . Neurol India [serial online] 2012 [cited 2019 Aug 20];60:678-9. Available from: http://www.neurologyindia.com/text.asp?2012/60/6/678/105224


Sir,

A 53-year-old woman presented with decreased visual acuity of 1 month duration, and neurological examination confirmed the same. Endocrine workup revealed a mild increase in the serum prolactin level. Magnetic resonance imaging (MRI) demonstrated a 2.4 cm ΄ 2.2 cm ΄ 1.8 cm mass with snowman configuration located in the sellar region. Some part of the mass exhibited isointensity on both T1-weighted and T2-weighted sequences, while the other parts exhibited hyperintensity [Figure 1]a and b. Subtotal resection of the tumor was done by a transnasal transsphenoidal approach. During the operation, the tumor was found to be tough and hypervascular and it invaded the basal bone of the pituitary fossa and sellar diaphragm. The specimen mainly contained short spindle cells positive for CD34, CD99 and bcl-2 [Figure 1]c on immunohistochemistry staining. The morphologic features and immunohistochemistry findings were that the tumor was of mesenchymal origin and consistent with solitary fibrous tumors (SFT). In the immediate postoperative period, transient central diabetes insipidus and hypopituitarism occurred, but there was marked improvement in her vision. She was discharged 10 days after surgery and the 3-month postoperative MRI showed small residual lesion. The patient refused to receive radiotherapy, and follow-up visits demonstrated no neurologic deficits and normal pituitary functions. There was no growth of the residual tumor 7 months after the surgery.
Figure 1: (a) and (b) revealed heterogeneous contrast enhancement of the lobular tumor (c) Strong immunoreactivity for bcl-2 (400)

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SFTs are mesenchymal spindle cell tumors, and are characterized by positive immunoreactivity to CD34, vimentin and bcl-2. [1] These tumors were first described by Klemperer and Rabin in 1931. [2] They usually occur in the pleura; however, there have been reports from many extrapleural sites including the central nervous system (CNS). There were only three reports of sellar SFTs [3],[4],[5] [Table 1] one case of involvement of pituitary fossa. [6] The reported cases of SFTs of CNS were mostly intracranial and the age distribution was wide, from fetus to 81 year old, with no gender difference in the mortality. [7] Surgery is the first line of the treatment while radiotherapy can be considered in patients with subtotal resection. Long-term prognosis remains unclear and close, careful follow-up is strongly recommended. [5],[7]

Clinically, sellar SFTs present with visual disturbance because of the location of the tumor, and other symptoms include headache, ophthalmalgia and nocturia. [3],[4],[5] In our patient, the MRI revealed a mass with heterogeneous contrast enhancement similar to another reported case. [3] Intracranial SFTs on contrast MRI may have marked heterogeneous enhancement [8] or homogeneous or heterogeneous enhancement. [7] We consider that the heterogeneous contrast enhancement on MRI might be one of the characteristics of sellar SFT that differentiates nonfunctional pituitary adenoma preoperatively. The tumor was found to be tough and hypervascular during operation, which we think is another characteristic of sellar SFT. Our patient had transient central diabetes insipidus and hypopituitarism postoperatively and received hormone replacement therapy with tapering dosage schedules. One month later, her pituitary function recovered a lot and, 3 months later, the pituitary function almost recovered. We suggest monitoring the hormone profile and administering hormone replacement therapy in patients with sellar SFT, especially for those patients with hypopituitarism.


  Acknowledgment Top


The additional immunohistochemical staining was supported by the Foundation of Science and Technology Department of Sichuan Provience (2009JY0032).

The authors would like to thank Xincheng Xue and Youping Li for helping with data collection and editing of the article.

 
  References Top

1.Hanau CA, Miettinen M. Solitary fibrous tumor: Histological and immunohistochemical spectrum of benign a nd malignant variants presenting at different sites. Hum Pathol 1995;26:440-9.  Back to cited text no. 1
    
2.Klemperer P, Rabin CB. Primary neoplasms of the pleura: A report of five cases. Arch Pathol 1931;11:385-412.  Back to cited text no. 2
    
3.Furlanetto TW, Pinheiro CF, Oppitz PP, de Alencastro LC, Asa SL. Solitary fibrous tumor of the sella mimicking pituitary adenoma: An uncommon tumor in a rare location: A case report. Endocr Pathol 2009;20:56-61.  Back to cited text no. 3
    
4.Yin WN, Ma CX, Wu J, Cai BW, You C. A primary atypical solitary fibrous tumor of the sella mimicking nonfunctional pituitary adenoma: A case report. Acta Neurochir (Wien) 2010;152:519-22.  Back to cited text no. 4
    
5.Pakasa NM, Pasquier B, Chambonniere ML, Morrison AL, Khaddage A, Perret AG, et al. Atypical presentations of solitary fibrous tumors of the central nervous system: An analysis of unusual clinicopathological and outcome patterns in three new cases with a review of the literature. Virchows Arch 2005;447:81-6.  Back to cited text no. 5
    
6.Cassarino DS, Auerbach A, Rushing EJ. Widely invasive solitary fibrous tumor of the sphenoid sinus, cavernous sinus, and pituitary fossa. Ann Diagn Pathol 2003;7:169-73.  Back to cited text no. 6
    
7.Bisceglia M, Galliani C, Giannatempo G, Lauriola W, Bianco M, D'angelo V, et al. Solitary fibrous tumor of the central nervous system: A 15-year literature survey of 220 cases (August 1996-July 2011). Adv Anat Pathol 2011;18:356-92.  Back to cited text no. 7
    
8.Weon YC, Kim EY, Kim HJ, Byun HS, Park K, Kim JH. Intracranial solitary fibrous tumors: Imaging findings in 6 consecutive patients. AJNR Am J Neuroradiol 2007;28:1466-9.  Back to cited text no. 8
    


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