Recurrent spindle cell Oncocytic pituicytoma. Case report of a rare tumor and a brief review of the literature

Spindle cell oncocytic pituicytoma (SCOP) is a rare, frequently misdiagnosed low-grade glial pituitary tumor of the posterior pituitary pituicytes. It is one of the sellar and suprasellar tumors, which also include pituitary adenomas, meningiomas, and granular cell tumors. Due to the imaging and histopathologic similarity of SCOPS to this set of sellar and suprasellar tumors, its diagnosis can be challenging, and frequently misdiagnosed as one of the other tumors. To differentiate SCOP from other tumors, immunohistochemistry (IHC) studies are essential. SCPOs belong to the family of Grade 1 tumors of the World Health Organization (WHO) classification of tumors. SCOPs are very vascular and adherent tumors, which cause difficulty in most cases during excision, leading to subtotal excision.

In this report, a multidisciplinary approach to the management of these tumors is emphasized, with the use of surgery as the main intervention along with adjuvant treatment and the use of longitudinal imaging. Occasional postoperative medical endocrine issues, including the development of a hypopituitarism phenomenon, will need close monitoring and hormonal treatment. It should be noted that recurrence is frequent despite the apparent control of the disease.

Greater awareness among the clinical community, and in particular, neurosurgeons, neuropathologists, and endocrinologists of SCOPS is essential for optimal diagnosis and management. Early diagnosis and correct identification are significant, not only to plan the surgical intervention, but also to differentiate the long-term plans of care and prevent underdiagnosis or a late spectrum of care.

The case complements the limited literature on this entity and is based on the need to always exercise vigilance, even with histologically benign tumors.