J Pathol Transl Med.  2021 May;55(3):225-229. 10.4132/jptm.2021.01.27.

Spindle cell oncocytoma of the sella turcica with anaplastic features and rapid progression in short-term follow-up: a case report with proposal of distinctive radiologic features

• Kim DJ
• Lee S
• Kim Ms
• Hwang JH
• Hahm MH

• KMID: 2515927
• DOI: http://doi.org/10.4132/jptm.2021.01.27

Abstract

We present a rare case of spindle cell oncocytoma (SCO) of the sella turcica with malignant histologic features and rapid progression. A 42-year-old woman experienced bilateral blurred vision and was preoperatively misdiagnosed as having a pituitary macroadenoma on magnetic resonance imaging. After surgery, SCO was diagnosed by the histopathologic features of interlacing fascicles of spindle tumor cells with finely granular, eosinophilic cytoplasm. Focal anaplastic changes and necrosis were present. Immunohistochemically, the tumor cells were positive for vimentin, epithelial membrane antigen, S-100, galectin-3, and thyroid transcription factor 1. Four months later, the tumor had progressed, and second surgery with adjuvant radiotherapy was performed; the patients remains under observation. In this report, we proposed distinctive radiologic features for differential diagnosis between SCO and other pituitary tumors.

Keyword

Oncocytoma; Sella turcica; Neoplasms; Progression; Radiology

Figure

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  Fig. 1 Preoperative magnetic resonance imaging. Coronal dynamic contrast enhanced T1-weighted imaging, early arterial phase (A), delayed phase (B), and coronal T2-weighted imaging (C). Note the late central stellate enhancement (black arrowheads). White arrowheads indicate the paper-thin compressed optic chiasm.

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  Fig. 2 Immediate postoperative contrast enhanced magnetic resonance imaging (MRI) (A) and 4-month follow-up MRI (B). Note the residual solid lesion including the superior part of the mass on immediate postoperative MRI (arrows) and rapid progression of the mass refilling the operation cavity.

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  Fig. 3 Histopathologic findings. (A) The tumor is composed of interlacing fascicles of spindle cells with abundant eosinophilic cytoplasm. (B) Focal nuclear pleomorphism and hyalinized stroma are seen. (C) Focal coagulative tumor necrosis is present. The tumor cells show immunoreactivity for galectin-3 (D) and thyroid transcription factor 1 (E). (F) The Ki-67 index was 26.7%. (G) Ultrastructural examination using paraffin-embedded tissue block show numerous mitochondria (white arrow) in tumor cell.

Reference

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