Granular cell tumors of the sellar region: what should be done after subtotal resection? A systematic review
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Granular cell tumors of the sellar region: what should be done after subtotal resection? A systematic review Franco Rubino1 · Rafael Martinez‑Perez2 · Samuel Vieira2 · Daniel Seclen Voscoboinik1 · Miguel Mural1 · Anna J. Orr2 · Douglas A. Hardesty2,3 · Ricardo L. Carrau2,3 · Daniel M. Prevedello2,3
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Granular cell tumors (GCT) are highly vascularized and adherent to adjacent structures, and so, complete resection represents a challenge. Adjuvant therapy decisions for residual GCTs currently relies on individual clinician decisions due to a paucity of systematic literature data. We present a comprehensive analysis about the impact of adjuvant therapy in reported cases of patients with incomplete GCT resection. Methods One database (PubMed) and crossed references were queried for GCT with incomplete resection or biopsy from 1962 to 2020. Literature review was performed according to the PRISMA guidelines. Also, two patients with residual GCT from our institutions are added to the analysis. Data regarding clinical presentation, surgical approach, use of adjuvant therapy, Ki-67 labeling, and follow up assessments were extracted and analyzed from selected publications. Results Thirty-three studies met the predetermined inclusion criteria and 53 patients were selected (including our two reported cases). The median of age was 49 [IQR, 39–60 years], with a slight male predominance (1.2:1). Among the surgical procedures, seven (13%) were biopsies alone. Adjuvant therapy was used in 18 patients (radiotherapy, 94.5%; chemotherapy, 5.5%) but there is no statistical correlation with adjuvant therapy and the progression of the remnant tumor (p = 0.33). Our institutions’ patients did not receive adjuvant therapy and did not show tumor progression on MRI. Conclusion Our systematic literature review suggests there is a limited role for chemo and/or radiotherapy in the management of incomplete GCT resection. It may be reasonable recommending close clinical follow up in patients with incomplete resection. Keywords Granular cell tumor · Posterior pituitary tumors · Adjuvant therapy · Incomplete resection · Rare sellar region tumors Abbreviations GCT Granular cell tumor STR Subtotal resection PR Partial resection MRI Magnetic resonance imaging CT Computed tomography * Daniel M. Prevedello [email protected]; [email protected] 1
Department of Neurological Surgery, Hospital Nacional Posadas, Buenos Aires, Argentina
2
Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, N‑1049 Doan Hall, Columbus, OH 43210, USA
3
Department of Otolaryngology Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
GTR Gross total resection RT Radiotherapy CTX Chemotherapy CFU Close follow up WHO World Health Organization
Introduction Granular cell tumors (GCT) (a.k.a. choristoma, granular cell myoblastoma or granular cell pituicytoma) were initi
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