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Pituicytoma: Diagnostic Features on Selective Carotid Angiography and MR Imaging

W.N. Gibbsa, E.S. Monukib, M.E. Linskeyc and A.N. Hassod

a School of Medicine, University of California, Irvine
b Departments of Pathology and Developmental and Cell Biology, University of California, Irvine
c Departments of Neurosurgery, University of California, Irvine Medical Center
d Department of Radiology, University of California, Irvine Medical Center


Figure 1
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  		Fig 1. A, Sagittal MR image shows a rounded mass in the suprasellar region, extending to the third ventricle. B, Coronal enhanced scan shows intense enhancement of the mass lesion, which appears to originate in the suprasellar region with fairly well-defined margins. The pituitary stalk, however, is not seen as a structure separate from the mass.


Figure 2
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  		Fig 2. Selective bilateral internal carotid artery (ICA) angiograms. A, Early arterial lateral, (B) late arterial anteroposterior (AP), and (C) venous lateral magnified views of the left ICA injection. There are numerous vascular pedicles arising from the supraclinoid portion of the ICA that represent the various inferior and superior hypophyseal branches (arrows, A and B) that supply the neurohypophysis and hypothalamus. The meningohypophyseal trunk, which supplies the inferior hypophyseal artery as well as the dorsal meningeal artery, is also visible, arising from the posterior genu of the cavernous ICA (arrowheads). During the venous phase (C), the tumor stain is apparent, extending from the suprasellar region upwards in a "dumbbell" or "mushroom" pattern. There is a prominent portal vein draining into the dural venous sinus (arrow). D, Late venous phase of the lateral injection of the right ICA. The shape of the tumor stain is well seen with a caudad extension along the enlarged pituitary stalk and cephalad extension into the hypothalamus. The delayed tumor stain and prominence of the meningohypophyseal trunk at first glance suggest a meningioma of the diaphragma sella and suprasellar region.


Figure 3
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  		Fig 3. Tumor histopathology.

A, The solid and cellular neoplasm is composed of rounded-to-spindled cells growing in a storiform pattern. No necrosis, nuclear palisading (Schwannoma), whorls (meningioma), or collagen bands (solitary fibrous tumor) are detected. Occasional large-caliber vessels are present, but the rich capillary network of the tumor is difficult to discern at low power (H&E, original magnification x10).

B, The tumor cells have abundant eosinophilic cytoplasm that lacks granularity. Tumor cell nuclei are large and have open chromatin, and many have a small distinct nucleolus. The rich capillary network is now visible. No mitotic figures, Rosenthal fibers, or eosinophilic granular bodies (pilocytic astrocytoma) are seen (H&E, original magnification x20).

C, The tumor shows strong and diffuse staining for S-100 in both the cytoplasm and nuclei of individual tumor cells (S-100, H&E, original magnification x20, x40).

D, The endothelial cell marker CD34 highlights the rich vascular/capillary network of the tumor, whereas tumor cells are negative for this marker (CD34 stain, original magnification x20).


Figure 4
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  		Fig 4. Color anatomic dissection of the sellar region. Frontal view of the optic chiasm and dissected diaphragma sella. The superior hypophyseal arteries are seen to branch into the pituitary stalk (Pit. Stalk) and extend cephalad toward the optic chiasm. (Reprinted with permission from Rhoton AL Jr. The sellar region. Neurosurgery 2002;51(suppl 1):335–74, [8.1])





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X