Intraventricular pituicytoma
Pituicytoma is a rare glial neoplasm from pituicytes of the neurohypophysis or infundibulum. It occurs in the sella and suprasellar area, and it is extremely uncommon to observe intraventricular pituicytoma without affecting the infundibulum or infundibular recess.
The term “intraventricular pituicytoma” suggests that this tumor is located within the ventricular system of the brain, which is an uncommon location for this type of tumor.
Key Characteristics
Symptoms: Symptoms of an intraventricular pituicytoma depend on its size, growth rate, and exact location within the ventricles. Common symptoms could include headaches, visual disturbances, hydrocephalus (due to blockage of cerebrospinal fluid flow), nausea, vomiting, and signs of increased intracranial pressure.
Diagnosis: Diagnostic imaging, especially MRI (Magnetic Resonance Imaging), is critical for identifying and characterizing these tumors. On MRI, pituicytomas typically appear as well-defined, non-enhancing lesions. However, their appearance can sometimes be similar to other types of brain tumors, such as gliomas or meningiomas, necessitating a biopsy for a definitive diagnosis.
Treatment: The primary treatment for intraventricular pituicytoma is surgical resection. The goal is to remove as much of the tumor as possible while preserving neurological function. Due to their benign nature, complete surgical removal often leads to a good prognosis, and recurrence is rare. Radiotherapy and chemotherapy are not typically used, as these tumors are slow-growing and do not usually respond to such treatments.
Prognosis: The prognosis for patients with intraventricular pituicytoma is generally favorable, especially if the tumor can be fully resected. Recurrences are uncommon due to the benign nature of the tumor, but regular follow-up imaging is recommended to monitor for any signs of regrowth.
In summary, an intraventricular pituicytoma is a rare, benign tumor of the brain that can cause symptoms due to its location within the ventricular system. Diagnosis typically involves imaging and histological analysis, and treatment is primarily surgical.
A 69-year-old man had suffered progressive dementia for 6 months. Magnetic resonance imaging revealed a solid, homogeneously enhancing mass with flow voids within the anterior third ventricle. The sella, suprasellar area, infundibulum, and infundibular recess were unaffected. The patient underwent a transcallosal transchoroidal approach, which ended in partial removal of the tumor due to significant tumoral bleeding. A second surgery resulted in its subtotal removal. The tumor had bipolar cells; their nuclei were immunoreactive for thyroid transcription factor-1. A DNA methylation analysis corresponded to the methylation class of pituicytoma, granular cell tumor, and spindle cell oncocytoma. Pituicytoma was the diagnosis based on these results. A systematic review identified 5 intraventricular pituicytoma cases.
Intraventricular pituicytoma can grow without the involvement of the infundibulum or infundibular recess. The current case suggests that pituicytes of the hypothalamic tuber cinereum can also give rise to pituicytoma. Because of the hypervascular nature of intraventricular pituicytomas, it is imperative to control intraoperative bleeding with attention to the adjacent hypothalamus 1).