Supra-sellar granular cell tumor: Report of a case with literature review

Farah Sassi; Alia Zehani; Abdelhafidh Slimane; Imed Ben Said; Khedija Bellil; Slim Haouet

doi:10.1016/j.ijscr.2023.108977

Supra-sellar granular cell tumor: Report of a case with literature review

Int J Surg Case Rep. 2023 Nov:112:108977. doi: 10.1016/j.ijscr.2023.108977. Epub 2023 Oct 24.

Authors

Farah Sassi¹, Alia Zehani², Abdelhafidh Slimane³, Imed Ben Said³, Khedija Bellil², Slim Haouet²

Affiliations

¹ Pathology Department, Rabta Hospital, Tunisia Faculty of Medicine, University of Tunis el MANAR, Tunis, Tunisia. Electronic address: sassi.farah@outlook.fr.
² Pathology Department, Rabta Hospital, Tunisia Faculty of Medicine, University of Tunis el MANAR, Tunis, Tunisia.
³ Department of Neurosurgery, National Institute of Neurology Tunis, Tunisia Faculty of Medicine, University of Tunis el MANAR, Tunisia.

Abstract

Introduction and importance: Granular cell tumor (GCT) originating from the sellar and suprasellar regions, specifically from the neurohypophysis, is a rare neoplasm. Distinguishing GCT from other pituitary tumors, including pituitary adenoma, pituicytoma, and spindle cell oncocytoma, poses significant challenges. Here, we present a rare case of GCT originating from the posterior pituitary in the supra-sellar region.

Case presentation: A 41-year-old woman, with no past medical history, presented to neurology department with decreased visual acuity and peripheral facial paralysis since 3 months. The MRI showed a well-defined supra-sellar, retrochiasmatic, oblong, hypothalamic expansive process. It was isointense T1-weighted, discretely hypotensive T2-weighted, measuring 19x17x16 mm, suggesting pituicytoma or craniopharyngioma. An endoscopic transsphenoidal surgical resection was performed. Microscopic examination showed a proliferation of diffuse architecture made up of rounded polyhedral cells with granular eosinophilic cytoplasm. On immunohistochemistry, tumor cells expressed diffusely TTF1, S-100 protein and SOX-10 confirming the diagnosis of supra-sellar GCT.

Discussion and conclusion: GCTs are rare neoplasms that predominantly exhibit benign behavior, while the malignancy rate remains at 2 %. Histopathology serves as the definitive diagnostic approach for GCTs. These tumors are resistant to radiotherapy and chemotherapy, necessitating surgical resection as the primary treatment modality. Due to the potential absence of distinct tumor masses and local tissue infiltration by tumor cells, complete excision is crucial, with resection extent extending beyond areas of infiltration.

Keywords: Granular cell tumor; Magnetic resonance imaging findings; Neurohypophysis; Pathology; Thyroid transcription factor 1.

Publication types

Case Reports