Posterior pituitary tumors: clinicopathological features and patient outcomes from a referral pituitary center

Posterior pituitary tumors (PPTs) are rare pathologies universally identified by positive immunoreactivity for thyroidtranscription factor-1 (TTF-1). They include four subtypes: pituicytoma (PC), granular cell tumor (GCT), spindle cell oncocytoma (SCO),and sellar ependymoma (SE). Because these tumors are rare, data regarding the optimal treatment strategy and prognosis are lacking. The aim of our study was to describe a large single-center cohort of patients with PPTs.

We retrospectively analyzed data from 15 patients diagnosed with PPTs among 2108 patients who underwent pituitary surgery at our institution between 2009 and 2024, examining their clinical presentations, imaging studies, surgical techniques, and recovery trajectories. The mean age was 50.5 years (range, 18-74 years). The mean follow-up time was 6.4 years (range, 0-15 years).

We describe eight cases of PC, four of SCO, and three of GCT. The most common symptoms were visual impairment (46.7%) and headache (40.0%). Thirteen patients (86.7%) underwent endoscopic transsphenoidal surgery, ten of whom achieved gross total resection (GTR).

The endoscopic transsphenoidal approach has proven to be a safe and highly effective method for achieving GTR in patients with PPTs. Spindle cell oncocytoma, with a higher level of vascularization than PC and GCT, poses a greater risk of surgical complicationsand may result in non-GTR.