Rare neurohypophyseal tumor presenting as giant pituitary macroadenoma with cavernous sinus invasion – A case report and review of literature

Abstract

Background: Granular cell tumors (GCTs) of the pituitary are rare tumors of posterior pituitary that can present as giant pituitary macroadenoma due to the slow indolent growth of the tumor. We are reporting this case due to the rarity of GCT and usually these tumors are confined to the suprasellar region since they are arising from the pituitary stalk. GCTs that attain such giant size with cavernous sinus invasion are still rarer. Case Description: A 38-year-old female who presented with progressive deterioration of vision and on evaluation by magnetic resonance imaging showed a giant pituitary macroadenoma with bilateral cavernous sinus invasion. The patient underwent pterional craniotomy and near-total excision of the lesion was done due to high vascularity and firmness of the tumor. Histopathology examination of the lesion showed spindle to globular cells with granular cytoplasm and was reported as GCT of the pituitary. Conclusion: GCTs are WHO grade1 non-neuroendocrine tumors arising from neurohypophysis and infundibulum. Complete excision is usually difficult due to the high vascularity, firm consistency, and local invasion of the tumor to the cavernous sinus and optic apparatus.

Recommendation to improve the WHO classification of posterior pituitary tumors as a unique entity: evidence from a large case series

“…In clinical practice, PPTs are uncommon and are often misdiagnosed as pituitary adenomas or craniopharyngiomas before operation. Previous studies have suggested that PPTs are hypervascularized ( 3 , 4 ); thus, clinical suspicion of PPTs before surgery is a real challenge. Recent advances in endoscopic surgery have provided better illumination and close-up observation during transsphenoidal surgery ( 5 , 6 ).…”