Endocrine Abstracts

Introduction: Spindle cell oncocytoma (SCO) of the pituitary gland is a rare thyroid transcription factor 1 (TTF-1)-positive pituitary neoplasm.

Observation: We report the case of a 42-year-old man, with a personal history of type 2 diabetes, consulting for intense headaches and vomiting. The visual field shows an amputation of the left temporal hemifield and the MRI shows a pituitary adenoma with suprasellar development, initially measuring 22×28×37 mm, taking contrast heterogeneously and presence of hemorrhagic areas. The biological assessment objectified a normal level of prolactin and a triple deficit corticotrope, thyrotrope and gonadotrope. The diagnosis of pituitary apoplexy was retained. The patient received high-dose corticosteroid therapy. 20 days later, MRI showed a reduction in tumor volume measuring 22×17×21 mm with normalization of the visual field. The patient was put on 2 mg per week of cabergoline with regular monitoring. Two years later the MRI showed an increase in tumor volume 18×26×16.6 with bitemporal hemianopsia. The patient underwent transphenoidal surgery. The pathology concludes to a spindle cell oncocytoma of the hypophysis. Two months later, the visual field has not improved. The MRI shows an increase in the size of the lesion measuring 18×26×24 mm.

Discussion: SCO was first described by Roncaroli et al. in 2002, subsequently less than 100 cases have been described in the literature. Clinically, biologically and morphologically SCOs are indistinguishable from other sellar tumors. The usual presentation is that of an intracranial tumor syndrome associated with pan hypopituitarism. However, a recent data showed that frequent endocrine-related symptoms, hypervascular signs, and anterosuperior displacement of the gland support preoperative diagnosis of SCO. The tumor is classified in the WHO classification of tumors of the central nervous system from 2007 as grade I. It consists of spindle cells with eosinophilic, finely granular, mitochondria-rich cytoplasm, shows immunoreactivity to TTF-1, and lacks expression of chromogranin and pituitary hormones. Global tumor resection (GTR) seems to have better long-term tumor control, whereas the fibrous, hypervascular, and adhesive nature of SCO makes it difficult to achieve GTR. In patients with non-GTR, radiotherapy may help decrease tumor progression. In our case, we opted for revision surgery followed by radiotherapy.