Posterior pituitary tumours: patient outcomes and determinants of disease recurrence or persistence

in Endocrine Connections
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  • 1 L Das , Endocrinology , Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 2 K Vaiphei, Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 3 A Rai, Translational and Regenerative Medicine , Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 4 C Ahuja, Radiology , Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 5 P Singh , Radiology , Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 6 I Mohapatra , Medanta, Gurgaon, India
  • 7 R Chhabra, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 8 A Bhansali, Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 9 B Radotra , Histopathology , Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 10 A Grossman, Endocrinology , Barts and The London School of Medicine and Dentistry William Harvey Research Institute, London, United Kingdom of Great Britain and Northern Ireland
  • 11 M Korbonits, Endocrinology , Barts and The London School of Medicine and Dentistry William Harvey Research Institute, London, United Kingdom of Great Britain and Northern Ireland
  • 12 P Dutta, Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence: Pinaki Dutta, Email: pinaki_dutta@hotmail.com

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 ten years. 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 (≥20.5mm 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.