Granular Cell Tumor and Spindle Cell Oncocytoma of the Pituitary Gland: Imaging and Intraoperative Cytology Diagnostic Dilemmas and Management Challenges

Background Tumors arising from the posterior pituitary gland are rare and closely resemble pituitary adenoma in presentation and imaging. Most of them come as a histopathologic surprise. We have analyzed the posterior pituitary tumors managed in our institute and have discussed the dilemmas in imaging, challenges in intraoperative squash cytology, and surgical management. Methods We retrospectively reviewed our operative database of pituitary tumors over the past 10 years, which included five posterior pituitary tumors (three granular cell tumors [GCTs] and two spindle cell oncocytomas [SCOs]). Clinical, imaging, and endocrine characteristics; intraoperative details; histopathologic features; and postoperative outcomes were collected and analyzed. Results The mean age of the patients was 47 years. All patients presented with varying degrees of vision loss. Radiology revealed a sellar / suprasellar lesion with the pituitary gland seen separately in two of three GCTs, whereas a separate pituitary gland could not be identified in both the SCOs. Pituitary adenoma was a radiologic diagnosis in only two of five cases. Three patients underwent a transsphenoidal surgery, whereas two underwent surgery by the transcranial approach. Intraoperative cytology was challenging, though a possibility of posterior pituitary tumor was considered in three of four cases, whereas one was considered meningioma. All the tumors were very vascular and influenced the extent of resection. Conclusions GCTs and SCOs are relatively uncommon tumors that are difficult to diagnose on preoperative imaging. Intraoperative squash cytology too can pose challenges. A preoperative suspicion can prepare the surgeon for surgery of these hypervascular tumors. The transcranial approach may be necessary in cases of uncertainty in imaging.

Evaluating intraoperative cytology with histopathology diagnosis and its importance in ovarian tumors

Background: Touch/ imprint cytology has been utilized for intraoperative evaluations of tumors to complement frozen sections in order to reach diagnosis prior to histopathology diagnosis. The main aim of this study is to find role of touch imprint in determining histopathology diagnosis of ovarian neoplasm. Materials and Methods: All together one hundred three cases were evaluated using both touch/imprint and histopathology diagnosis. The histopathology diagnoses consisted of Benign (n=85), borderline (n=4), and malignant (n=12). Touch imprint cytology consists of Negative for malignancy (n=90), Positive for malignancy (n=11) and inadequate (n=2). Inadequate smear was excluded from the study. Results: Both touch / imprint cytology were able to diagnose benign and malignant ovarian neoplasm. Out of 103 cases, in cytology showed 89.1% patients were negative and 10.9% patients were positive. Histopathology shows 84.2% of benign ovarian neoplasm, 3.9% borderline neoplasm and 11.9% of malignant. Diagnostic accuracy of touch/ imprint was 99% with sensitivity 100% and specificity was 91.67%. Positive predictive value was 98.89% and negative predictive value was 100%. Conclusion: Touch/ imprint cytology examination is simple, rapid and useful test in evaluation of ovarian neoplasms. It plays very important role in preliminary intraoperative diagnosis of benign and malignant ovarian neoplasms.