Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 58, Num. 5, 2010, pp. 799-801

Neurology India, Vol. 58, No. 5, September-October, 2010, pp. 799-801

Letter to Editor

Pituicytoma: Case report and review of the literature

Fan Zhang, Jing Chen, Chao You

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

Correspondence Address:
Fan Zhang
Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan
China
zhangfan19841117@gmail.com

Date of Acceptance: 14-Jul-2010

Code Number: ni10225

PMID: 21045523

DOI: 10.4103/0028-3886.72187

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.

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.

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

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