Endocrine Abstracts

Background: Pituitary adenomas are the commonest Sellar neoplasm, there are number of other differential diagnosis based on histopathological features and immune histochemical characteristics. Pituicytomas are rare tumours of sellar and suprasellar region which originate from pituicytes which are specialised glial cells of neurohypophysis and infundibulum.

Case report: A 63-year-old lady with a background history of bilateral cataract corrected with surgery and astigmatism presented with 1 year history of worsening occipital headache and progressive visual deterioration. CT brain done for evaluation of headache revealed pituitary macroadenoma and subsequent MRI pituitary revealed intra and supra sellar mass of 2.1 cm in cranio-caudal diameter, extending to the third ventricle and compressing the optic chiasm. She had bilateral slightly reduced visual fields on perimetry. Endocrine evaluation revealed prolactin of 760 mU/l and hypogonadotropic hypogonadism with normal thyroid, adrenal and growth hormone axis. With the preoperative diagnosis of non-functioning pituitary adenoma patient has undergone uncomplicated transsphenoidal adenectomy and post-operative recovery was uneventful. Histology revealed a vascular tumour comprising of spindle cells arranged in storiform pattern with inconspicuous mitotic figures. Immunohistochemistry was positive for vimentin, s100 and TTF1 and negative for synaptophysin, Cam5-2, pituitary hormones, pituitary transcription factors and EMA. There was occasional positivity for GFAP. Ki-67 index was 5% and BRAF mutation was negative. With the characteristic immunohistological features the tumour was diagnosed as pituicytoma. Patient is awaiting post operative MRI to decide on subsequent management.

Conclusions: Clinical presentation and radiological characteristics of pituicytomas are nonspecific, and diagnosis typically made based on immunohistopathological results. Tumours are usually slow growing and benign and amenable to surgery; however, surgical treatment may be challenging due to the hypervascularity. Prognosis seems to be favourable, long term follow-up studies are required to assess the behaviour and the best therapeutic option.