Treatment and prognostic factors of pituicytoma: a single-center experience and comprehensive literature review

Abstract

Purpose Preoperative diagnosis of pituicytomas is difficult, and management and prognostic factors remain ambiguous. The purpose of this study was to elucidate the radiological characteristics of pituicytoma, to assess the risk factors affecting tumor progression, and to propose the optimal treatment regimen based on comprehensive analysis. Methods We reviewed the clinical data of 22 patients with pituicytoma confirmed pathologically in our institution. In addition, 93 cases of pituicytoma in the previous literature were recruited. The individual data of 115 patients were analyzed to evaluate the adverse factors affecting pituicytoma progression. Results In the combined cohort, 3 of 61 patients who underwent gross-total resection (GTR) developed recurrence (4.9%); of the 54 patients who received non-GTR, 19 progressed (35.2%). Univariate and multivariate Cox regression analysis verified male gender (HR 2.855, 95% CI 1.008–8.089; p = 0.048), TS (transsphenoidal surgery; HR 3.559, 95% CI 1.015–12.476; p = 0.047), and non-GTR (HR 4.388, 95%CI 1.240–15.521; p = 0.022) were independent unfavorable factors for pituicytoma progression. A multivariate logistic regression model verified that tumor diameter ≥ 1.85 cm (OR 4.859, 95% CI 1.335–17.691; p = 0.016) was independent adverse factors for GTR. Compared with TS, OT (open transcranial) is more likely to have postoperative complications (OR 3.185, 95% CI 1.020–9.944; p = 0.046), especially vision deterioration (OR 37.267, 95% CI 4.486–309.595; p = 0.001). Conclusion Based on our findings, GTR was advocated as an optimal treatment for pituicytomas. However, in order to avoid damage to important structures, partial resection is acceptable. After that, adjuvant radiotherapy is recommended for male patients with high Ki-67 index, and the remaining patients can be followed up closely. When the tumor recurs or progresses, it is recommended to re-operate and remove the lesion completely as far as possible. If GTR is still not possible, postoperative radiotherapy for the residual tumor is recommended.

Pituicytoma Associated with Suspected Cushing’s Disease: Two Case Reports and a Literature Review

“…We presumed that the decreased blood supply in the pituitary stalk region after surgery is a possible cause. In this situation, the relatively ample vascularization, a frequently noticed feature of pituicytomas [ 19 ], which was also described in case 1, might rebuild later and help the neoplasm prominently recur during follow-up. Another assumption was hypophysitis, which might be secondary to sellar tumors and contribute to pituitary stalk thickening, reaching partial remission after surgery.…”

Pituicytoma: A rare tumor of the sella. A case report and review of literature for diagnosis and management

“…Pituicytomas, germinomas, meningiomas, hamartomas, and craniopharyngiomas are categorized among posterior pituitary tumors originating from neurohypophysis. [1,22] Among these, pituicytomas further include granular cell tumors or choristomas and pilocytic astrocytomas which are often misdiagnosed and it is difficult to differentiate them from other brain neoplasms located in the same region. [7] CNS tumors of glial origin are benign and were classified by the WHO in 2006 where it termed them pituicytoma differently from astrocytomas under low Grade-1 glial tumors.…”

“…Tumor located in the sellar area tends to exhibit endocrine dysfunction and those present in the suprasellar region, presents with structural compression symptoms such as headache, vomiting, and visual disturbances. [4,22] Here, we report a case of histopathologically diagnosed pituicytoma of the sellar region. Literature is also reviewed and discussed to gain a better understanding of this rare disease.…”

“…Tumor located in the sellar area tends to exhibit endocrine dysfunction and those present in the suprasellar region, presents with structural compression symptoms such as headache, vomiting, and visual disturbances. [ 4 , 22 ]…”

Pituicytoma: A rare case report of sellar and suprasellar tumor

“…Given the benign and slow-growing characteristics of pituicytomas, asymptomatic patients may choose a wait-and watch approach. When the tumor recurs or progresses, it is recommended to re-operate and remove the lesion completely as far as possible [16] , [17] .…”