Spindle cell oncocytoma of the neurohypophysis with metastasis to the sphenoparietal sinus and immunohistochemical negativity for S100 and epithelial membrane antigen (EMA)

Abstract

We report the case of a 61-year-old male with spindle cell oncocytoma of the hypophysis. On presentation to the Department of Neurosurgery at the German Armed Forces Hospital of Ulm, the patient reported a history of several years of left sixth nerve palsy, right ptosis, increased sensitivity to light, and a bilateral retrobulbar pressure sensation. Pituitary function was normal. A chromophobe non-functioning pituitary adenoma was initially suspected. The diagnosis was established on the basis of examination at a histopathology reference laboratory using immunohistochemistry to identify cell surface markers. During two years of follow-up, there were two clinical recurrences requiring surgery. To our knowledge, this is the 35th documented case of spindle cell oncocytoma of the pituitary gland and the first that was immunohistochemically negative for epithelial membrane antigen (EMA) and S100; and the first that displayed haematogenous metastasis to the right sphenoparietal sinus. The three surgical procedures were associated with massive intraoperative bleeding and thus resulted in subtotal tumor resection. Following surgery for the recurrences, the patient underwent radiotherapy.

Keywords:

• Spindle cell oncocytoma
• pituitary gland
• neurohypophysis
• absence of S100 and EMA expression
• radiotherapy
• surgical resection
• proton and heavy-ion therapy

Disclosures

No potential conflict of interest was reported by the authors.

Author contributions

Study conception and design: HW, CS. Acquisition of data: HW, CS. Analysis of data and preparation of figures and tables: HW. Immunohistochemical analysis: WS. Drafting of manuscript: HW. Critical revision and final approval of the version to be published: all authors.

Additional information

Funding

The Department of Neuropathology (WS) has received support from Novartis Pharma GmbH (Nuremberg), Novo Nordisk Pharma GmbH (Mainz), Pfizer Pharma GmbH (Karlsruhe), and Ipsen Pharma GmbH (Berlin).