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Symptomatic granular cell tumor of the pituitary gland: case report and review of the literature.

OBJECTIVE AND IMPORTANCE
The posterior pituitary lobe is rarely the site of symptomatic primary tumors. The most common lesions arising from the neurohypophysis and the pituitary stalk seem to be granular cell tumors (GCTs), of which only 42 symptomatic cases have been reported. Here we present an unusually well-documented case of a GCT, which has implications for the differential diagnosis of sellar masses.


CLINICAL PRESENTATION
A 75-year-old woman presented with decreased visual acuity, visual field loss, and a 2-year history of progressive vertigo and headaches. Neuroradiological studies showed a supra- and intrasellar, 25 x 20-mm mass, containing calcifications, that compressed the optic chiasm and extended into the third ventricle.


INTERVENTION
The tumor was subtotally resected through a transsphenoidal approach. The tumor was tough and vascular and could not be suctioned. Histological examination revealed a typical GCT. The postoperative course was uneventful. Residual tumor was treated with fractionated radiation therapy. Ophthalmological testing 10 months after surgery showed a slight improvement in the visual symptoms.


CONCLUSION
Tumor calcifications in computed tomographic scans do not exclude a GCT. The diagnosis requires histological confirmation. Surgical removal by the transsphenoidal approach is the therapy of choice, as for other sellar tumors. Radiation therapy may be advisable after subtotal resection. Our literature review suggests the possibility of gender-related tumor biology in GCTs.