# Pituitary Spindle Cell Oncocytoma: More than a Grade 1 Tumor?

## TL;DR

Pituitary spindle cell oncocytomas are rare tumors that behave more aggressively than their grade suggests, requiring careful diagnosis, treatment, and follow-up.

## Contribution

The paper highlights the need for adjuvant radiotherapy and close monitoring due to the tumor's high recurrence risk.

## Key findings

- Pituitary SCOs have high vascularity and strong adherence to surrounding structures, leading to higher recurrence rates.
- Adjuvant radiotherapy should be considered when complete resection is not achieved.
- Diligent follow-up is essential to detect recurrence or progression.

## Abstract

Background/Objectives: Spindle cell oncocytomas (SCOs) of the pituitary gland are rare tumors often misdiagnosed for nonfunctioning pituitary macroadenomas. Although classified as grade 1, they are often challenging in terms of diagnosis and treatment. Pituitary SCOs harbor peculiar features such as hypervascularity and stronger adherence to surrounding structures, with increased risk of hemorrhage, partial resection, and significantly higher recurrence rate. Almost 100 cases have been reported so far. The role of surgery is still crucial for the decompression of the optic chiasm as well as for achieving diagnosis. However, given the higher tendency of recurrence, the role of postoperative radiotherapy has been investigated over the last few years. Case presentation: Here, we reported a case of a 48-year-old female with a pituitary SCO treated at our institution, in which we focused on diagnosis, treatment, and follow-up. Conclusions: This type of tumor presents a challenge related to its higher vascularity and strong adherence to the surrounding structures. Adjuvant radiotherapy is something that should be considered, especially when gross total resection is not achieved, and finally, SCOs require diligent follow-up to monitor for any signs of disease recurrence or progression.