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TTF1-positive posterior pituitary tumors: a single-center experience of 10 years
Elisa Lamback1,2,3, Aline Helen da Silva Camacho2, Anna Clara Castro Araujo1
1Neuroendocrinology Research Center, Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Purpose:
Primary TTF1-positive posterior pituitary tumors (PPT) are uncommon and frequently misdiagnosed preoperatively. This study aims to describe our experience with PPT, examining clinical, radiological and histopathological data, as well as surgical and clinical outcomes.
Methods:
We conducted a retrospective review of medical records from patients treated at a single neurosurgical center between 2013 and 2023. Immunohistochemistry for TTF-1 was performed using AB_1158934.
Results:
Nine PPT were included: 6 spindle cell oncocytomas (SCO), 2 granular cell tumor (GCT) and 1 pituicytoma. The median age was 53 years (range 34-70), with six (66.7%) patients being male. Most patients presented preoperatively with panhypopituitarism (8 cases), visual impairment (7 cases) and headache (7 cases). The median largest tumor diameter of 2.7 cm (range 1.7-5.4 cm) and PPT appeared isointense on T1W. SCO typically manifested as large intrasellar tumors with suprasellar extension and pronounced contrast-enhancement. GCT and pituicytoma were predominantly suprasellar lesions, with GCT showing a characteristic "star-like crack" pattern. Surgical outcomes varied, with the minority of successful cases involving SCO, known for their hypervascularity and firm consistency.
Conclusion:
PTT constituted 0.6% of sellar/suprasellar surgeries at our center. SCO should be suspected if a large and significant contrast-enhancement lesion is seen, and GCT if there is a suprasellar tumor with a "star-like crack" pattern. Surgical outcomes were not favorable: the majority of cases showed subtotal resection requiring adjuvant radiotherapy. Long-term follow-up is crucial due to the limited curative outcomes observed in most patients.
