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Spindle cell oncocytoma of the adenohypophysis in a woman: a case report and review of the literature
© Mlika et al; licensee BioMed Central Ltd. 2011
Received: 4 March 2010
Accepted: 14 February 2011
Published: 14 February 2011
Spindle cell oncocytoma of the adenohypophysis is a rare tumour recently reported by Roncaroli et al. in 2002. This tumour is considered a grade I tumour by the World Health Organization.
We describe what is, to the best of our knowledge, the 14th case of its kind in the literature. A 45-year-old African woman presented clinical and radiological findings related to a nonfunctioning pituitary adenoma. The diagnosis was made on the basis of histological and immunohistochemical findings.
The purpose of this work is to report a rare pituitary tumour and to describe its histological and immunohistochemical features, which were characterized by the expression of thyroid transcription factor 1 antigen by tumour cells. This fact could support the theory of a possible common origin of these tumours in pituicytomas. In fact, thyroid transcription factor 1 is considered to be a specific marker of pituicytes.
Spindle cell oncocytoma (SCO) of the pituitary gland is a recently described entity which was recognized by the 2007 WHO Classification of Brain Tumours and considered a WHO grade I tumour . It was initially described by Roncaroli et al. in 2002 , and only 14 cases have been reported in the literature. The histogenesis and prognosis of these tumours remain uncertain and need to be documented more thoroughly in the literature. Our aim is to report a new case of SCO and to describe its histological and immunohistochemical features supporting the theory of a possible common origin with pituicytoma .
Cases reported in the literaturea
Year of publication
Number of reported cases
Sex ratio (M/F)
Mean age (yr)
Roncaroli et al. 
Panhypopituitarism, visual defect
Dahiya et al. 
Kloub et al. 
Recurrence after 1 and 11 yr
Vajtai et al. 
Adynamia, decrease of visual acuity
Borota et al. 
Demmsie et al. 
Visual blurring, weight loss
Recurrence after 9 mo
Coiré et al. 
Recurrence after 5 mo
The radiological findings are nonspecific and do not differentiate these tumours from pituitary adenomas. In our case, they consisted of an enhanced mass of the sellar region.
Histological and immunohistochemical features
Histological examination is the only means of diagnosis [2–4]. This tumour is typically composed of interlacing fascicles of spindled to epithelioid cells with oncocytic cytoplasm. Mild to moderate nuclear atypia and even focal marked pleomorphism may be seen. The immunoprofile of these tumours is characterized by simultaneous positivity for S-100 protein, vimentin and EMA. Ultrastructurally, the neoplastic cells contain numerous mitochondria with lamellar cristae. The neoplastic cells are linked by intermediate junctions and desmosomes [1, 5].
These histological, immunohistochemical and fine structural features lead most authors to postulate a possible derivation of these tumours from folliculostellate cells. Very little is known about the functioning of the folliculostellate cells. Some authors have reported that these cells are implicated in long-distance communication in the anterior pituitary gland [6–8]. These cells are known to coexpress the S-100 protein, vimentin and galectin 3. These findings are shared by the SCO, but in our case tumour cells also expressed TTF-1. Lee et al.  described the expression of TTF-1 in eight cases of SCO. They reported that TTF-1 is generally expressed in fetal neurohypophysis. According to these findings, this marker could be specific to human pituicytes. The positivity of TTF-1 in our observation with these eight reported cases should lead to further research that could have implications for the classification of these rare sellar neoplasms and may indicate a similar origin of SCO and pituicytoma .
Immunohistochemical findings in spindle cell oncocytoma and the main differential diagnosesa
Spindle cell oncocytoma
S-100 protein, vimentin and EMA are expressed
Oncocytic variant of meningioma
EMA is expressed, vimentin is expressed and S-100 protein is negative
Granular cell tumour
CD68 is expressed
GFAP is expressed
Oncocytic neoplasm originating from salivary gland remnants
Epithelial markers are expressed, S-100 protein and EMA are negative
Oncocytic variant of a pituitary adenoma
Synaptophysin and chromogranin are expressed
SCOs of the pituitary gland are rare tumours whose pathogenesis and management remain debated because of the few numbers of reported cases. These tumours are considered to have a good prognosis despite the early recurrences reported in some cases [8, 9]. Additional clinical follow-up is needed to assess the prognostic features. In our case, the period of follow-up was too short, so we can only speculate whether such a tumour is benign.
Written, informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
We thank Dr Nadia Kourda from Charles Nicolle Hospital for her contribution in taking the photos.
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