Posterior pituitary tumours: patient outcomes and determinants of disease recurrence or persistence. Issue 4 (April 2021)

• Record Type: Journal Article
• Authors: Das, Liza; Vaiphei, Kim; Rai, Ashutosh; Ahuja, Chirag Kamal; Singh, Paramjeet; Mohapatra, Ishani; Chhabra, Rajesh; Bhansali, Anil; Radotra, Bishan Dass; Grossman, Ashley B; Korbonits, Márta; Dutta, Pinaki
• Is Part Of: Endocrine connections. Volume 10:Issue 4(2021)
• Page Start: 387
• Page End: 400
• Publication Date: 2021-04
• Subjects: pituicytomas -- posterior pituitary tumours -- spindle cell oncocytomas -- TTF-1; Endocrinology -- Periodicals; 616.4005
• DOI: 10.1530/EC-20-0621
• Languages: English
• ISSNs: 2049-3614

Abstract

Abstract : Objective: Posterior pituitary tumours (PPTs) are rare neoplasms with the four recognised subtypes unified by thyroid transcription factor -1 (TTF-1) expression, according to the 2017 WHO classification. Though traditionally defined as low-grade neoplasms, a substantial proportion of them show recurrence/persistence following surgery. Methods: We selected patients with PPTs in our cohort of 1760 patients operated for pituitary tumours over the past 10 years (2010–2019). The clinical, radiological, hormonal, histopathological profiles and long-term outcomes of the three cases identified (two pituicytomas and one spindle cell oncocytoma, SCO) were analysed. Following a literature review, data of all published cases with documented TTF-1 positive pituicytomas and SCOs were analysed to determine the predictors of recurrence/persistence in these tumours. Results: Patients presented with compressive features or hypogonadism. Two had sellar-suprasellar masses. One had a purely suprasellar mass with a pre-operative radiological suspicion of pituicytoma. Two were operated by transsphenoidal surgery and one transcranially guided by neuronavigation. Histopathology confirmed spindle cells in a storiform arrangement and low Ki67 index. Immunohistochemistry showed positive TTF-1, S-100 expression and variable positivity for EMA, vimentin and GFAP. Re-evaluation showed recurrence/persistence in two patients. A literature review of recurrent/persistent pituicytoma ( n = 17) and SCO ( n = 9) cases revealed clinical clues (headache for pituicytomas, male gender for SCO), baseline tumour size (≥20.5 mm with sensitivity exceeding 80%) and longer follow-up duration as determinants of recurrence/persistence. Conclusion: PPTs are rare sellar masses with quintessential TTF-1 positivity. Recurrent/persistent disease following surgery is determined by greater tumour size at baseline and duration of follow-up. This warrants intensive and long-term surveillance in these patients.