Atypical Granular Cell Tumor of the Sellar Region

  • Rhee, Deok-Joo (Departments of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Yoon-La (Departments of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Suh, Yeon-Lim (Departments of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Kwan (Departments of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Published : 2006.12.31

Abstract

We report a very rare case of atypical granular cell tumor arising in the neurohypophysis of a 56-year-old woman. The tumor was seen on radiology to be lobulated, soft and diffusely enhanced, the same as pituitary macroadenoma, but it was anatomically localized within the posterior part of the hypophysis. We partially removed the tumor via the transsphenoidal approach. The pathology showed nuclear pleomorphism, spindling features, and lymphoplasmacytic infiltration. Ki-67 and S-100 protein were focally positive in tumor cells. Histological diagnosis confirmed an atypical granular cell tumor in the sellar region, which is a rare tumor that often has the clinical appearance of a pituitary adenoma. Ophthalmologic symptoms are the most common, followed by endocrinologic manifestations. Here we describe its symptoms and radiological and pathological features.

Keywords

References

  1. Albuquerque L, Pimentel J, Costa A, Cristina L : Cerebral granular cell tumors : report of a case and a note on their nature and expected behavior. Acta Neuropathol 84 : 680-685, 1992
  2. Buhl R, Hugo HH, Hempelmann RG, Barth H, Mehdorn HM : Granularcell tumour : a rare suprasellar mass. Neuroradiology 43 : 309-312, 2001 https://doi.org/10.1007/s002340000507
  3. Cohen-Gadol AA, Pichelmann MA, Link MJ, Scheithauer BW, Krecke KN, Young WF Jr, et al : Granular cell tumor of the sellar and suprasellar region : clinicopathologic study of 11 cases and literature review. Mayo Clin Proc 78 : 567-573, 2003
  4. Cone L, Srinivasan M, Romanul FC : Granular cell tumor(Choristoma) of the neurohypophysis : Two cases and a review of the literature. AJNR 11 : 403-406, 1990
  5. Doron Y, Behar A, Beller A : Granular-cell 'myoblastoma' of the neuryhypohysis. J Neurosurg 22 : 95-99, 1965 https://doi.org/10.3171/jns.1965.22.1.0095
  6. Figarella-Branger D, Dufour H, Fernandez C, Bouvier-Labit C, Grisoli F, Pellissier JF : Pituicytomas, a mis-diagnosed benign tumor of the neurohypophysis : report of three cases. Acta Neuropathol 104 : 313- 319, 2002
  7. Fanburg-Smith JC, Meis-Kindblom JM, Fante R, Kindblom LG : Malignant granular cell tumor of the soft tissue : diagnostic criteria and clinicopathologic correlation. Am J Surg Pathol 22 : 779-794, 1998 https://doi.org/10.1097/00000478-199807000-00001
  8. Giangaspero F, Cenacchi G : Oncocytic and granular cell neoplasm of the central nervous system and pituitary gland. Semin Diagn Pathol 16 : 91-97, 1999
  9. Halbauer DJ, Meszaros I, Doczi T, Kajtar P, Pajor L, Kovacs K, et al : Rare sellar region tumors. Pathol Oncol Res 9 : 134-137, 2003 https://doi.org/10.1007/BF03033759
  10. Higuchi M, Tsuji M, Ikeda H : Symptomatic hypophyseal granular cell tumor : endocrinological and clinicopathological analysis. Br J Neurosurg 11 : 582-586, 1997 https://doi.org/10.1080/02688699745790
  11. Hurley TR, D'Angelo CM, Clasen RA, Wilkinson SB : Magnetic resonance imaging and pathological analysis of a pituicytomas : case report. Neurosurgery 35 : 314-317, 1994 https://doi.org/10.1227/00006123-199408000-00021
  12. Iglesias A, Arias M, Brasa J, Paramo C, Conde C, Fernandez R : MR imaging finding in granular cell tumor of the neurohypophysis : a difficult preoperative diagnosis. Eur Radiol 10 : 1871-1873, 2000 https://doi.org/10.1007/s003300000488
  13. Ji CH, Teng MM, Chang T : Granular cell tumor of the neurohypophysis. Neuroradiology 37 : 451-452, 1995 https://doi.org/10.1007/BF00600090
  14. Kasashima S, Oda Y, Nozaki J, Shirasaki M, Nakanishi I : A case of atypical granular cell tumor of the neurohypophysis. Pathol Int 50 : 568-573, 2000 https://doi.org/10.1046/j.1440-1827.2000.01080.x
  15. Kim SH, Kim SH, Kim TS : Symptomatic granular cell tumor involving intra-and suprasellar area : A case report. Korean J Pathol 33 : 745-750, 1999
  16. Kudawara I, Ueda T, Yoshikawa H : Granular cell tumor of the subcutis : CT and MRI findings. A report of three cases. Skeletal Radiol 28 : 96- 99, 1999 https://doi.org/10.1007/s002560050481
  17. Lima A, Antunes L, Tome F : Pituicytoma or granular-cell myoblastoma of the pituitary gland : report of case. J Neurosurg 17 : 778-782, 1960 https://doi.org/10.3171/jns.1960.17.4.0778
  18. Losa M, Saeger W, Mortini P, Pandolfi C, Terreni MR, Taccagni G, et al : Acromegaly associated with a granular cell tumor of the neurohypophysis : a clinical and histological study. Case report : J Neurosurg 93 : 121-126, 2000 https://doi.org/10.3171/jns.2000.93.1.0121
  19. Moriyama E, Matsumoto Y, Meguro T, Mano S : Suprasellar granular cell tumor. Neurol Med Chir 36 : 237-240, 1996 https://doi.org/10.2176/nmc.36.237
  20. Nakamura T, Hirato J, Hotchi M, Kyoshima K, Nakamura Y : Astrocytoma with granular cell tumor like changes. Report of a case with histochemical and ultrastructural characterization of granular cells. Acta Pathol Jpn 40 : 206-211, 1990
  21. Nishio S, Takeshita I, Yoshimoto K, Yamaguchi T : Granular cell tumor of the pituitary stalk. Clin Neurol Neurosurg 100 : 144-147, 1998 https://doi.org/10.1016/S0303-8467(98)00017-1
  22. Rhee JS, Wackym PA, Hague K, Wolfe D, King WA : Granular cell tumor of the pituitary fossa. Ann Otol Rhinol Laryngol 111 : 754-758, 2002 https://doi.org/10.1177/000348940211100818
  23. Rickert CH, Kuchelmeister K, Gullotta F : Morphological and immunohistochemical characterization of granular cells in non-hypophyseal tumours of the central nervous system. Histopathology 30 : 464-471, 1997 https://doi.org/10.1046/j.1365-2559.1997.5360788.x
  24. Rossi ML, Bevan JS, Esiri MM, Hughes JT, Adams CB : Pituicytoma (piliocytic astrocytoma). Case report. J Neurosurg 67 : 768-772, 1987 https://doi.org/10.3171/jns.1987.67.5.0768
  25. Satyamurti S, Huntington HW : Granular cell myoblastoma of the pituitary. Case report. J Neurosurg 37 : 483-486, 1972 https://doi.org/10.3171/jns.1972.37.4.0483
  26. Schlachter LB, Tindall GT, Pearl GS : Granular cell tumor of the pituitary gland associated with diabetes insipidus. Neurosurgery 6 : 418-421, 1980
  27. Shuangshoti S, Chantra K, Navalitloha Y, Charoonwatanalaoha S, Shuangshoti S : Atypical granular cell tumor of the neurophysis : a case report with review of the literature. J Med Assoc Thai 81 : 641-646, 1998
  28. Symon L, Burston J, Gonz JC : Granular cell myoblastoma of the neurohypophysis. Report of two cases. J Neurosurg 35 : 82-89, 1971 https://doi.org/10.3171/jns.1971.35.1.0082
  29. Tomita T, Gates E : Pituitary adenomas and granular cell tumors. Incidence, cell type, and location of tumor in 100 pituitary glands at autopsy. Am J Clin Pathol 111 : 817-825, 1999 https://doi.org/10.1093/ajcp/111.6.817
  30. Vogelgesang S, Junge MH, Pahnke J, Gaab MR, Warzok RW : August 2001 : Sellar/suprasellar mass in a 59-year-old woman. Brain Pathol 12 : 135-136, 2002
  31. Wilkinson MD, Fulham MJ, Besser M : Neuroimaging findings in a suprasellar granular cell tumor. J Comput Assist Tomogr 27 : 26-29, 2003 https://doi.org/10.1097/00004728-200301000-00005