To cite this article: Neuroendocrinol Lett 2013; 34(5):331–338 CASE REPORT Neuroendocrinology Letters Volume 34 No. 5 2013 Granular cell tumor of the neurohypophysis: Case report and review of the literature Leonard Saiegh 1 , Majed Odeh 2 , Mohammad Sheikh-Ahmad 1 , Maria Reut 1 ,Zvi Ram 3 , Carmela Shechner 1 1 Endocrinology Department, Bnai-Zion Medical Center, Haifa, Israel 2 Department of Internal Medicine A, Bnai-Zion Medical Center, Haifa, Israel 3 Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel Correspondence to: Leonard Saiegh, MD. Endocrinology Department, Bnai-Zion Medical Center, Haifa, Israel. tel: +97248359510; fax: +97248359519; e-mail: leonard.saiegh@gmail.com Submitted: 2013-07-09 Accepted: 2013-07-30 Published online: 2013-08-03 Key words: granular cell tumor; pituitary gland; neurosurgical procedures; hypophysis; neurohypophysis Neuroendocrinol Lett 2013; 34(5):331–338 PMID: 23922042 NEL340513C02 © 2013 Neuroendocrinology Letters • www.nel.edu Abstract A 54-year-old woman presented with a stalk mass that was discovered incidentally with mild visual fields defect. The mass was operated surgically by the fronto- temporal approach, and histology met the diagnosis of neurohypophesial granular cell tumor (GCT). After surgery, the patient suffered from an irreversible severe bi-temporal visual deficit and an irreversible hypopituitarism. We review the literature and discuss the clinical nature of GCTs, treatment options and outcome. In an effort to avoid the severe complications that may result from surgical removal of neurohypophesial GCT, we discuss also the possibility of choosing the conservative approach with close follow-up. The tumor’s firm consistency, tendency to hemorrhage, involving the pituitary stalk and lack of dissection plane from basal brain structure render surgery difficult, and maximal resection often requires sacrificing the stalk. Moreover, small asymptomatic neurohypophysial GCTs are common findings, most probably benign tumors with slow growing nature. Hence, for a neurohypophesial tumor which is suspected to be a GCT, we offer to consider the alternative approach, with close clinical, visual field and radiological study follow up. INTRODUCTION Granular cell tumors (GCTs) may occur in any anatomic site in the body, but they have a rare occurrence in the sellar region (Rickert et al. 1997). Yet, they have been incidentally reported in 6.5% to 17% of autopsies examining posterior pituitary and stalk (Schanklin 1947; 1953). The majority of reported cases have revealed a benign behavior of the tumor with malignancy being extremely rare (Shuangshoti et al. 1998). Nonetheless, there are few papers that reported large tumors that led to the emergence of symptoms (Satyamurti & Hun- tington 1972). Depending on the size of the lesion, the trans-sphenoidal or trans-cranial approach is selected in order to remove GCTs (Alleyne et al. 2002). Due to the firm consistency of the tumor and to its high vascularity, sometimes only sub- total removal of the tumor is possible (Schaller et al. 1998). We present here a case report of a woman with a stalk mass that was discovered incidentally with a minimal visual field deficit. The mass was oper- ated surgically by the fronto-temporal approach, and histology met the diagnosis of GCT. After surgery, the patient suffered from an irreversible severe bi-temporal visual deficit and an irrevers- ible hypopituitarism.