Pituitary spindle cell oncocytoma: illustrative case - PubMed (original) (raw)

. 2021 Oct 4;2(14):CASE21356.

doi: 10.3171/CASE21356. Print 2021 Oct 4.

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Pituitary spindle cell oncocytoma: illustrative case

Taha M Taka et al. J Neurosurg Case Lessons. 2021.

Abstract

Background: Spindle cell oncocytoma (SCO) of the pituitary gland is an extremely rare nonfunctional World Health Organization grade I tumor. SCOs are often misdiagnosed as nonfunctional pituitary adenomas on the basis of preoperative imaging. They are often hypervascular and locally adherent, which increases hemorrhage risk and limits resection, leading to increased risk of recurrence. The authors report a case of SCO treated at their institution and provide a review of the current literature.

Observations: SCO of the pituitary gland can be a rare cause of progressively growing pituitary tumors that presents similarly to nonfunctional pituitary adenoma. Endoscopic transsphenoidal resection of the tumor by a multidisciplinary team allowed total resection despite local adherence of the tumor. Postoperatively, the patient's visual symptoms improved with persistence of secondary adrenal insufficiency and secondary hypothyroidism.

Lessons: Careful resection is needed due to SCO's characteristic hypervascularity and strong adherence to minimize local structure damage. Long-term follow-up is recommended due to the tendency for recurrence.

Keywords: oncocytoma; pituitary; sella; skull base surgery.

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Conflict of interest statement

Disclosures Dr. Kuan reported consulting income from Stryker ENT outside the submitted work.

Figures

FIG. 1.

FIG. 1.

Preoperative MRI scans of the patient 2 days before scheduled surgery. A: An axial T2 fluid-attenuated inversion recovery image. B: An axial T2-weighted three-dimensional image. C: A coronal image. D: A sagittal image. The enhancing intra- and suprasellar tumor mass can be seen around the center of all four images near the pituitary location and was measured to be 1.5 × 1.6 × 3.1 cm.

FIG. 2.

FIG. 2.

MRI scan of the patient 1 day postoperatively. The left and right images present a coronal image and sagittal image, respectively. There was no midline shift or herniation; however, residual small areas of suprasellar enhancement and persistent deformity of the anterior third ventricle can be seen in both images.

FIG. 3.

FIG. 3.

Distribution of SCO occurrence throughout the decades of life in male and female patients.

References

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