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| LETTER TO EDITOR |
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| Year : 2013 | Volume
: 61
| Issue : 5 | Page : 545-546 |
Pituitary ependymoma: Report of a rare case with an insight into the histogenesis
Vengalathur Ganesan Ramesh1, Kavindapadi Veerasamy Karthikeyan1, Shyamala Rajaraman2, Ramesh Rao3
1 Department of Neurosurgery, Chettinad Superspeciality Hospital, Chettinad Health City, Kelambakkam, Chennai, Tamil Nadu, India
2 Department of Otorhinolaryngology, Chettinad Superspeciality Hospital, Chettinad Health City, Kelambakkam, Chennai, Tamil Nadu, India
3 Department of Pathology, Chettinad Superspeciality Hospital, Chettinad Health City, Kelambakkam, Chennai, Tamil Nadu, India
| Date of Submission | 14-Jun-2013 |
| Date of Decision | 18-Jul-2013 |
| Date of Acceptance | 10-Oct-2013 |
| Date of Web Publication | 22-Nov-2013 |
Correspondence Address:
Vengalathur Ganesan Ramesh
Department of Neurosurgery, Chettinad Superspeciality Hospital, Chettinad Health City, Kelambakkam, Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.121948
How to cite this article:
Ramesh VG, Karthikeyan KV, Rajaraman S, Rao R. Pituitary ependymoma: Report of a rare case with an insight into the histogenesis. Neurol India 2013;61:545-6 |
Sir,
Ependymoma of pituitary gland is very rare and only six cases have been reported till date. [1],[2],[3],[4],[5],[6] We report yet another case.
A 32-year-old male patient presented with progressive dimness of vision in both eyes and headache of 2 months duration. Neurologic examination revealed normal ocular fundi and visual acuity and bitemporal hemianopia. He had no symptoms or signs of endocrine dysfunction. Magnetic resonance imaging showed evidence of sellar-suprasellar mass lesion suggestive of pituitary tumor [Figure 1]. Hormone profile was normal. Endonasal transsphenoidal excision of the tumor was done. Postoperatively, the visual field defects improved. He had transient diabetes insipidus. Histopathological picture showed clear ependymal cells with perivascular pseudorosettes and ependymal canal formation, suggestive of clear cell ependymoma [Figure 2]. Immunohistochemical staining showed a few cells positive for glial fibrillary acidic protein (GFAP) [Figure 3]. Patient had postoperative radiotherapy. | Figure 1: T2 Coronal MRI brain showing the pituitary tumour with suprasellar extension
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 | Figure 2: Histopathology picture (H and E, ×100) showing clear ependymal cells and pseudorosettes
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 | Figure 3: Immunohistochemistry (glial fibrillary acidic protein, ×400) showing positive staining for GFAP
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The common pituitary tumors are secreting and nonsecreting adenomas. The other tumors like oncocytoma, null cell adenoma are less common. Ependymoma, the common intraventricular tumor, is less common in the extraventricular sites. Sarkisian and Schultz (1959) reported the first case of pituitary ependymoma [1] . Only six cases of pituitary ependymoma have been reported so far [Table 1]. [1],[2],[3],[4],[5],[6]
There are no specific clinical or radiological features for pituitary ependymoma. The diagnosis is essentially on histopathology. Various theories have been postulated for the origin of ependymoma in the pituitary gland. Winer et al., had suggested the possible origin from the cell remnants in the ependymal clefts within the sella or heterotopic ependymal cells in the sella. [2] Scheithauer et al., had postulated a possible origin from the pituicytes in the posterior pituitary gland. [5] Thomson et al., also documented the neurohyopophyseal origin of the pituitary ependymoma. [3] We postulate that the "ependymal pituicytes" (described by Takei et al.) [7] in the posterior pituitary gland may undergo metaplasia to ependymal cells and may give rise to the pituitary ependymoma.
| » References | |  |
| 1. | Sarkisian SS, Schultz AL. Pituitary ependymoma. U S Armed Forces Med J 1956;7:1813-6. 
[PUBMED] |
| 2. | Winer JB, Lidov H, Scaravilli F. An ependymoma involving the pituitary fossa. J Neurol Neurosurg Psychiatry 1989;52:1443-4.
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| 3. | Thomson S, Chakrabarty A, Marks P. Ependymoma of the neurohypophysis. Br J Neurosurg 2001;15:277-8.
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| 4. | Mukhida K, Asa S, Gentili F, Shannon P. Ependymoma of the pituitary fossa. Case report and review of the literature. J Neurosurg 2006;105:616-20.
[PUBMED] |
| 5. | Scheithauer BW, Swearingen B, Whyte ET, Auluck PK, Stemmer-Rachamimov AO. Ependymoma of the sella turcica: A variant of pituicytoma. Hum Pathol 2009;40:435-40.
[PUBMED] |
| 6. | Belcher R, Chahal HS, Evanson J, Afshar F, Marino S, Grossman AB. Recurrent pituitary ependymoma: A complex clinical problem. Pituitary 2010;13:176-82.
[PUBMED] |
| 7. | Takei Y, Seyama S, Pearl GS, Tindall GT. Ultrastructural study of the human neurohypophysis. Cell Tissue Res 1980;205:273-87.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1]
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| Jonathan M. Parish,Jose M. Bonnin,Julius M. Goodman,Aaron A. Cohen-Gadol | | Journal of Clinical Neuroscience. 2015; 22(4): 638 | | [Pubmed] | [DOI] | |
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