Neurohypophyseal Granular Cell Tumor with Intratumoral Bleeding: Report of a Case

Abstract

Background: Symptomatic neurohypophyseal granular cell tumors (GCTs) are rare, and their main presenting symptoms are usually nonspecific. Rarely, neurohypophyseal GCTs manifest intratumoral bleeding. Case Description: A 77year-old woman presented with a 2-year history of headache and blurred vision, and sudden onset of visual disturbance one week before. Neurologically, she had constricted visual fields and endocrine studies revealed pituitary dysfunction. Brain computed tomography showed a hyperdense pituitary lesion with suprasellar extension, and magnetic resonance imaging demonstrated a pituitary tumor with a mixed isointense and hyperintense center surrounded by a hypointense rim on both T1 and T2 images. The tumor had mild heterogeneous enhancement at the center and linear enhancement at the margin. Subtotal tumor excision via the transsphenoidal approach was performed and nonclotted blood was found in the tumor. The postoperative course was complicated with meningitis and diabetes insipidus. After treatment with antibiotics and pitressin, her condition stabilized and her vision improved. Pathology revealed a granular cell tumor with bleeding. After 18 months of follow up, she was doing well with regular hormone replacement therapy. The patient refused radiotherapy for her residual tumor. Conclusion: Neurohypophyseal granular cell tumor rarely manifested as intratumoral bleeding. We present the clinical features of this patient and review the literature.