Pituicytoma Cases - Correlating Radiological, Pathological, and Surgical Outcomes: A systematic review and meta-analysis

Introduction : Pituicytomas are rare glial neoplasms originating from the neurohypophysis, often posing diagnostic and therapeutic challenges due to their nonspecific imaging features and limited case series in the literature. Their biological behavior, optimal management, and prognostic factors remain poorly defined. Objective: This systematic review and meta-analysis aim to synthesize available evidence on radiological, pathological, and surgical outcomes in pituicytoma, evaluating diagnostic accuracy and outcome predictors. Method: A comprehensive search was conducted using PubMed, Embase, Scopus, and Cochrane Library databases for studies published up to 2025. Included studies reported radiological findings (MRI, CT, [ ¹⁸ F]FET PET/MRI, angiography), histopathological markers, and surgical outcomes. Data on diagnostic modalities, imaging characteristics, immunohistochemical profiles, surgical approaches (transsphenoidal, transcranial, endoscopic), and outcomes (recurrence, progression, remission) were extracted. Data were extracted and analyzed using random-effects models due to expected heterogeneity. Random-effects meta-analysis assessed pooled recurrence rates, with heterogeneity evaluated via I² statistics. Results: A total of 233 articles were identified using predefined search terms. Four studies totaling 151 cases were included. Pituicytomas were predominantly sellar/suprasellar, isointense on T1-weighted MRI, hyperintense on T2-weighted MRI, and intensely enhancing. [ ¹⁸ F]FET PET/MRI showed 100% sensitivity for small functional tumors. Histopathologically, TTF-1, S100, and GFAP were consistently expressed. Gross-total resection (GTR) was achieved in 54.5–61% of cases, with a pooled recurrence rate of 4.9% (95% CI: 1.2–15.5%) versus 35.2% (95% CI: 22.7–49.8%) for non-GTR (Tau² = 0.1821, I² = 45.3%, P = 0.1395). Transsphenoidal surgery increased progression risk (HR: 3.559, 95% CI: 1.015–12.476). Male gender and tumor diameter ≥1.85 cm predicted progression. Complications included endocrine abnormalities (18.2%). Conclusion: Pituicytoma remains diagnostically challenging due to nonspecific imaging and clinical overlap with other sellar neoplasms. This meta-analysis underscores the diagnostic value of TTF-1 immunohistochemistry, supported by MRI features. Advanced imaging modalities such as [ ¹⁸ F]FET PET/MRI may further improve preoperative identification. Moderate heterogeneity suggests variability in outcomes, supporting tailored surgical strategies and long-term follow-up.