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---
title: "Granular Cell Tumor"
docid: "da976b04-85a3-4bf8-ac81-e579f081293e"
authors:
- key: "8d5254e9-8dda-478b-8f08-bdee97a32c79"
value: "Karen L. Salzman, MD, FACR"
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name: "Brain"
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name: "Diagnosis"
slug: "diagnosis"
treeNodeId: "51c00394-446e-4a38-94af-d3b1d14d34e8"
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name: "Anatomy-Based Diagnoses"
slug: "anatomy-based-diagnoses"
treeNodeId: "529d3e33-f508-498c-bc70-cf962e81e629"
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name: "Sella and Pituitary"
slug: "sella-and-pituitary"
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name: "Neoplasms"
slug: "neoplasms"
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name: "Granular Cell Tumor"
slug: "granular-cell-tumor"
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category: "Brain"
documentVersionId: "16196366-3704-4511-b91f-73ac70ac21c1"
imageCount: 6
lastUpdated: "08/05/20"
pageDescription: "Granular Cell Tumor"
pageKeywords: "Brain, Diagnosis, Anatomy-Based Diagnoses, Sella and Pituitary, Neoplasms, Granular Cell Tumor"
pageTitle: "Granular Cell Tumor | STATdx"
enhancedTitle: "Granular Cell Tumor"
type: "DX"
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breadcrumbs:
- "Brain"
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- "Sella and Pituitary"
- "Neoplasms"
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---
# KEY FACTS
- ## Terminology
- Neoplasms that arise from pituicytes, specialized glial cells of neurohypophysis or infundibulum
- Rare low-grade, nonendocrine neoplasms of sellar region
- Formerly called pituicytoma; granular cell tumor of neurohypophysis
- Part of 2017 WHO spectrum of thyroid transcription factor 1 (TTF-1) expressing pituitary tumors of posterior lobe
- ## Imaging
- Enhancing, well-circumscribed sellar/suprasellar or infundibular mass
- 1.5-6.0 cm
- CT: Sellar/suprasellar mass with hyperattenuation
- Rarely calcification may be present
- Best imaging tool: C+ MR with high-resolution imaging through sellar region
- Consider granular cell tumor if sellar/suprasellar mass appears separate from anterior pituitary gland
- ## Top Differential Diagnoses
- Pituitary macroadenoma
- Lymphocytic hypophysitis
- Pituicytoma
- Spindle cell oncocytoma
- Rathke cleft cyst
- ## Pathology
- WHO grade 1
- ## Clinical Issues
- Commonly asymptomatic (small lesions)
- Visual field deficit related to optic chiasm compression is most common presenting feature
- Less common symptoms: Panhypopituitarism, galactorrhea, amenorrhea, decreased libido, neuropsychological changes
- Typically present in adulthood, 5th-6th decades
- Generally benign clinical course
# TERMINOLOGY
- ## Abbreviations
- Granular cell tumor (GCT)
- ## Synonyms
- Formerly called pituicytoma; granular cell tumor of neurohypophysis
- ## Definitions
- Neoplasms that arise from pituicytes, specialized glia of neurohypophysis or infundibulum
- Rare low-grade, nonendocrine neoplasms of sellar region
- Part of 2017 WHO spectrum of thyroid transcription factor1 (TTF-1) expressing pituitary tumors of posterior lobe
# IMAGING
- ## General Features
- ### Best diagnostic clue
- Enhancing, well-circumscribed sellar/suprasellar or infundibular mass
- ### Location
- Sellar and suprasellar or infundibular mass
- ### Size
- 1.5-6.0 cm
- ### Morphology
- Lobulated and well circumscribed
- ## CT Findings
- ### NECT
- Sellar/suprasellar mass with hyperattenuation
- Rarely calcification may be present
- ## MR Findings
- ### T1WI
- Sellar/suprasellar mass isointense to gray matter
- ### T1WI C+
- Enhancement may be homogeneous or heterogeneous
- ## Imaging Recommendations
- ### Best imaging tool
- C+ MR with high-resolution imaging through sellar region
# DIFFERENTIAL DIAGNOSIS
- [Pituitary Macroadenoma](/document/pituitary-microadenoma/283f3068-d369-4f79-bf01-0f2b82c6e49b)
- Sellar and suprasellar enhancing mass
- Arises from adenohypophysis
- May be indistinguishable
- [Lymphocytic Hypophysitis](/document/lymphocytic-hypophysitis/f30774c3-cbd0-4ab3-b3d1-e0574106db1f)
- May be indistinguishable from macroadenoma
- May present as infundibular mass
- Typically pregnant or postpartum females
- [Pituicytoma](/document/pituicytoma/d6e481d5-7742-4354-8dfe-4f04286a709a)
- May be intrasellar or suprasellar mass
- May be separate from adenohypophysis
- [Spindle Cell Oncocytoma](/document/spindle-cell-oncocytoma/1557bfb2-8315-4782-9a1e-4e70d6d20c4e)
- Imaging mimics macroadenoma
- Enhancing sellar and suprasellar mass
- [Rathke Cleft Cyst](/document/rathke-cleft-cyst/8f1561f7-92a7-485c-a0ae-2e2d5c8c1628)
- Nonenhancing cystic sellar &/or suprasellar lesion
- Intracystic nodule in up to 75%
# PATHOLOGY
- ## General Features
- ### Associated abnormalities
- Granular cell tumors have been found in associated with adenomas
- Small granular cell clusters have been found in up to 17% of autopsy series
- ## Staging, Grading, & Classification
- WHO grade 1
- ## Gross Pathologic & Surgical Features
- Lobulated, well-circumscribed mass, soft but rubbery
- More firm than pituitary adenoma
- ## Microscopic Features
- Densely packed polygonal cells with abundant granular eosinophilic cytoplasm
- Electron microscopy: Cytoplasm is filled with phagolysosomes containing electron-dense material and membranous debris
# CLINICAL ISSUES
- ## Presentation
- ### Most common signs/symptoms
- Commonly asymptomatic (small lesions)
- Visual field deficit related to optic chiasm compression
- ### Other signs/symptoms
- Panhypopituitarism, galactorrhea, amenorrhea, decreased libido, neuropsychological changes
- Rarely diabetes insipidus
- ## Demographics
- ### Age
- Typically present in adulthood, 5th-6th decades
- ### Gender
- F:M = 2:1
- ## Natural History & Prognosis
- Rare (~ 150 reported cases)
- Generally benign clinical course
- ## Treatment
- Surgical resection
# DIAGNOSTIC CHECKLIST
- ## Image Interpretation Pearls
- Consider granular cell tumor if sellar/suprasellar mass appears separate from anterior pituitary gland
55b6bf2f-c975-435a-972b-a42c5b4cbe6d
## References
# Selected References
1. [Borg A et al: Tumors of the neurohypophysis: One unit's experience and literature review. World Neurosurg. 134:e968-e978, 2020](http://www.ncbi.nlm.nih.gov/pubmed/?term=31734425%5Bpmid%5D)
1. [Guerrero-Pérez F et al: Posterior pituitary tumours: the spectrum of a unique entity. A clinical and histological study of a large case series. Endocrine. 63(1):36-43, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=30276594%5Bpmid%5D)
1. [Guerrero-Pérez F et al: Posterior pituitary tumours: the spectrum of a unique entity. A clinical and histological study of a large case series. Endocrine. 63(1):36-43, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=30276594%5Bpmid%5D)
1. [Shibuya M: Welcoming the new WHO classification of pituitary tumors 2017: revolution in TTF-1-positive posterior pituitary tumors. Brain Tumor Pathol. 35(2):62-70, 2018](http://www.ncbi.nlm.nih.gov/pubmed/?term=29500747%5Bpmid%5D)
1. [Ahmed AK et al: Extent of surgical resection and tumor size predicts prognosis in granular cell tumor of the sellar region. Acta Neurochir (Wien). 159(11):2209-16, 2017](http://www.ncbi.nlm.nih.gov/pubmed/?term=28948361%5Bpmid%5D)
1. [Jian F et al: Surgical biopsies in patients with central diabetes insipidus and thickened pituitary stalks. Endocrine. 47(1):325-35, 2014](http://www.ncbi.nlm.nih.gov/pubmed/?term=24532100%5Bpmid%5D)
1. [Shizukuishi T et al: Granular cell tumor of the neurohypophysis with optic tract edema. Jpn J Radiol. 32(3):179-82, 2014](http://www.ncbi.nlm.nih.gov/pubmed/?term=24414885%5Bpmid%5D)
1. [Mete O et al: Spindle cell oncocytomas and granular cell tumors of the pituitary are variants of pituicytoma. Am J Surg Pathol. 37(11):1694-9, 2013](http://www.ncbi.nlm.nih.gov/pubmed/?term=23887161%5Bpmid%5D)
1. [Saiegh L et al: Granular cell tumor of the neurohypophysis: case report and review of the literature. Neuro Endocrinol Lett. 34(5):331-8, 2013](http://www.ncbi.nlm.nih.gov/pubmed/?term=23922042%5Bpmid%5D)
1. [Covington MF et al: Pituicytoma, spindle cell oncocytoma, and granular cell tumor: clarification and meta-analysis of the world literature since 1893. AJNR Am J Neuroradiol. 32(11):2067-72, 2011](http://www.ncbi.nlm.nih.gov/pubmed/?term=21960498%5Bpmid%5D)
1. [Mumert ML et al: Cystic granular cell tumor mimicking Rathke cleft cyst. J Neurosurg. 114(2):325-8, 2011](http://www.ncbi.nlm.nih.gov/pubmed/?term=20509726%5Bpmid%5D)
1. [Menon G et al: Symptomatic granular cell tumour of the pituitary. Br J Neurosurg. 22(1):126-30, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=17952719%5Bpmid%5D)
1. Fuller GN et el: Granular cell tumour of the neurohypophysis In Louis, DN et el: WHO Classification of Tumors of the Central Nervous System. 4th Ed. Lyon: IARC. 241-2, 2007
## Images
### Selected Images
![Sagittal T1 C+ MR in a 65-year-old woman shows an enhancing suprasellar mass <img src='img/arrows/CO.png'/>.](images/app.statdx.com_image_thumbnail_5ca8b84a-b148-4d75-a721-86afb09900bf_size_168_quality_85_6152a149_20251014T205304Z.jpg)
*Sagittal T1 C+ MR in a 65-year-old woman shows an enhancing suprasellar mass <img src='img/arrows/CO.png'/>.*
![Sagittal T1 C+ MR in a 65-year-old woman shows an enhancing suprasellar mass <img src='img/arrows/CO.png'/>.](images/app.statdx.com_image_thumbnail_5ca8b84a-b148-4d75-a721-86afb09900bf_size_174_quality_85_93e878e8.jpg)
*Sagittal T1 C+ MR in a 65-year-old woman shows an enhancing suprasellar mass <img src='img/arrows/CO.png'/>.*
![Coronal T1 C+ MR in the same patient shows the suprasellar enhancing mass <img src='img/arrows/CO.png'/> contacting the optic chiasm <img src='img/arrows/WS.png'/>. Imaging mimics the much more common pituitary macroadenoma. Granular cell tumors are rare low-grade, nonendocrine neoplasms arising from the infundibulum or neurohypophysis. These tumors are part of the 2017 WHO spectrum of TTF-1 expressing pituitary tumors of the posterior lobe.](images/app.statdx.com_image_thumbnail_37b27bcd-5ca6-4d76-b72f-601736dcfe13_size_168_quality_85_89773be0_20251014T205304Z.jpg)
*Coronal T1 C+ MR in the same patient shows the suprasellar enhancing mass <img src='img/arrows/CO.png'/> contacting the optic chiasm <img src='img/arrows/WS.png'/>. Imaging mimics the much more common pituitary macroadenoma. Granular cell tumors are rare low-grade, nonendocrine neoplasms arising from the infundibulum or neurohypophysis. These tumors are part of the 2017 WHO spectrum of TTF-1 expressing pituitary tumors of the posterior lobe.*
![Sagittal T1 MR in a 31-year-old woman with headache and visual complaints shows a sellar and suprasellar mass <img src='img/arrows/WO.png'/> with superior displacement of the optic chiasm <img src='img/arrows/WS.png'/>. There is a hyperintense focus <img src='img/arrows/CC.png'/> along the inferior aspect of the mass.](images/app.statdx.com_image_thumbnail_e25dc2dc-35c8-4cde-85d2-2a4a82a86aae_size_168_quality_85_bd87c0e3_20251014T205304Z.jpg)
*Sagittal T1 MR in a 31-year-old woman with headache and visual complaints shows a sellar and suprasellar mass <img src='img/arrows/WO.png'/> with superior displacement of the optic chiasm <img src='img/arrows/WS.png'/>. There is a hyperintense focus <img src='img/arrows/CC.png'/> along the inferior aspect of the mass.*
![Sagittal T1 C+ MR in the same patient shows peripheral enhancement <img src='img/arrows/WO.png'/> of the mass. The region of T1 hyperintensity is also seen, resembling an intracystic nodule <img src='img/arrows/CC.png'/>, typically seen in a Rathke cleft cyst. Granular cell tumor of the neurohypophysis was diagnosed at resection.](images/app.statdx.com_image_thumbnail_a887a4ff-115c-4cf2-8604-74d6473eba9a_size_168_quality_85_1a5a4e25_20251014T205304Z.jpg)
*Sagittal T1 C+ MR in the same patient shows peripheral enhancement <img src='img/arrows/WO.png'/> of the mass. The region of T1 hyperintensity is also seen, resembling an intracystic nodule <img src='img/arrows/CC.png'/>, typically seen in a Rathke cleft cyst. Granular cell tumor of the neurohypophysis was diagnosed at resection.*
### Additional Images
![Sagittal T1 C+ MR shows an enhancing mass along the superior infundibulum and anterior 3rd ventricle <img src='img/arrows/CO.png'/>. Granular cell tumor was diagnosed at resection.](images/app.statdx.com_image_thumbnail_0fb060d9-7fd7-4e32-befc-534cb8d7d572_size_168_quality_85_c1d2f18a_20251014T205304Z.jpg)
*Sagittal T1 C+ MR shows an enhancing mass along the superior infundibulum and anterior 3rd ventricle <img src='img/arrows/CO.png'/>. Granular cell tumor was diagnosed at resection.*
![Coronal T1 C+ MR shows a large sellar and suprasellar enhancing mass contacting the left optic chiasm <img src='img/arrows/WO.png'/>. Granular cell tumor was diagnosed at resection. Imaging mimics the much more common pituitary macroadenoma.](images/app.statdx.com_image_thumbnail_51f9669f-be82-4dd4-89b7-27b6c5fda51a_size_168_quality_85_8f77246c_20251014T205304Z.jpg)
*Coronal T1 C+ MR shows a large sellar and suprasellar enhancing mass contacting the left optic chiasm <img src='img/arrows/WO.png'/>. Granular cell tumor was diagnosed at resection. Imaging mimics the much more common pituitary macroadenoma.*
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