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Nemir J, Maric LS, Trbojevic T, Zarkovic K, Jadrijević-Cvrlje F. Papillary tumor of the pineal region in pediatric patient – A case report. Surg Neurol Int 2022; 13:488. [DOI: 10.25259/sni_867_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/24/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Papillary tumor of the pineal region (PTPR) represents a rare and histologically distinct subgroup of tumors originating in the pineal region. Few pediatric cases have been reported so far in the literature; therefore, clinical data are scarce.
Case Description:
We describe a case of PTPR in a 9-year-old girl who presented with a 5-month history of excessive appetite and weight gain. The patient underwent neuroimaging procedures and total gross surgical resection with postoperative adjuvant local radiotherapy, which from our experience was the best treatment choice as an attempt to avoid local recurrence. During 78-month follow-up, the patient from our study manifested no disease recurrence.
Conclusion:
PTPR should be included in the differential diagnosis of pineal region masses.
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Affiliation(s)
- Jakob Nemir
- Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Lorna Stemberger Maric
- Department of Pediatric Infectious Diseases, University Hospital for Infectious Diseases, Dr. Fran Mihaljevic, Zagreb, Croatia
| | - Tena Trbojevic
- Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Kamelija Zarkovic
- Department of Pathology, Clinical Medical Centre Zagreb, Zagreb, Croatia
| | - Filip Jadrijević-Cvrlje
- Department of Pediatrics, Division of Hematology and Oncology, Children’s Hospital Zagreb, Zagreb, Croatia
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2
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Mathkour M, Hanna J, Ibrahim N, Scullen T, Kilgore MD, Werner C, Cormier I, Spencer P, Keen JR, Bui CJ. Papillary tumor of the pineal region in pediatric populations: An additional case and systematic review of a rare tumor entity. Clin Neurol Neurosurg 2020; 201:106404. [PMID: 33360024 DOI: 10.1016/j.clineuro.2020.106404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
Papillary tumors of the pineal region (PTPR) are a rare tumor entity first described in 2003, later codified in the 2007 WHO tumor classification system. PTPRs most commonly occur in the third and fourth decades, with exceedingly rare presentations in pediatric populations. Herein, we present an additional case of a 10-year-old female found to have PTPR in conjunction with Trisomy 21 managed successfully with cerebrospinal fluid diversion and gross total resection (GTR). Three years after resection she has returned to baseline without recurrence. We also performed a comprehensive review of the current literature discussing the diagnosis, treatment, and pathophysiologic correlations in children. Diagnosis and management of PTPRs is a topic that is increasingly garnering attention in the literature given the recent characterization of this tumor entity. However, relatively little is known about the presentation of PTPRs in pediatric populations. In adults, PTPRs have been linked with several chromosomal and genetic abnormalities; however this correlation is limited in pediatric literature. Although GTR is the mainstay for treatment, the application of adult treatment protocols may not be advisable due to age and the developmental changes of the CNS in children.
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Affiliation(s)
- Mansour Mathkour
- Ochsner Health System, Department of Neurosurgery, New Orleans, LA, USA; Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA; Neurosurgery Division, Surgery Department, Jazan University, Jazan, Saudi Arabia.
| | - Joshua Hanna
- Ochsner Health System, Department of Neurosurgery, New Orleans, LA, USA; Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Naser Ibrahim
- Ochsner Health System, Department of Neurosurgery, New Orleans, LA, USA; Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Tyler Scullen
- Ochsner Health System, Department of Neurosurgery, New Orleans, LA, USA; Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Mitchell D Kilgore
- Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Cassidy Werner
- Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Ian Cormier
- Ochsner Health System, Department of Neurosurgery, New Orleans, LA, USA; Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Pierce Spencer
- Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Joseph R Keen
- Ochsner Health System, Department of Neurosurgery, New Orleans, LA, USA; Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Cuong J Bui
- Ochsner Health System, Department of Neurosurgery, New Orleans, LA, USA; Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
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Bromfield M, Profyris C, Mehtar A, Du Toit M, Wadee R. Papillary tumour of the pineal region: a case report. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00188-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Papillary tumor of the pineal region is an unusual, recently described entity with potential for misinterpretation as either an ependymoma or choroid plexus papilloma. With few reported cases, there is little data regarding the biologic behavior, natural course and optimal treatment for these patients. Further accumulation of reports will assist with defining this entity and may provide further insight into management of such patients.
Case presentation
This patient was a 24-year-old male with new onset seizures and a decreased level of consciousness. MRI scan showed a large heterogeneously enhancing solid-cystic mass in the pineal region extending to the third ventricle.
Discussion
Papillary tumor of the pineal region is a neuroepithelial tumor with distinct morphological and immunohistochemical features that can be utilized to help differentiate it from other primary and metastatic tumors occurring within this region. Although there is currently no clear consensus, the potential for disease progression and CSF dissemination supports early aggressive therapy in these patients.
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Yamaki VN, Solla DJF, Ribeiro RR, da Silva SA, Teixeira MJ, Figueiredo EG. Papillary Tumor of the Pineal Region: Systematic Review and Analysis of Prognostic Factors. Neurosurgery 2020; 85:E420-E429. [PMID: 30989225 DOI: 10.1093/neuros/nyz062] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 02/08/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical outcomes and biological behavior of papillary tumors of the pineal region (PTPR) are still under investigation. The best therapeutic strategy has not been defined. OBJECTIVE To perform a comprehensive patient-level analysis of all PTPR cases and identify their clinical features, treatment options, and prognostic factors. METHODS A search of the medical databases for case series and reports on PTPRs from January 2003 to June 2017 was performed. Data addressing PTPR's clinical presentation, imaging, treatment, and histological features were. Variables associated with the primary outcome of 36-mo survival were identified through Cox regression models. RESULTS The initial search yielded 1164 studies, of which 71 were included (60 case reports and 11 case series), containing 177 patients (mean age 33.0 ± 15.3 yr and 53.2% male). Intracranial hypertension and hydrocephalus prevailed as the clinical picture. Surgery was performed on 82.0% and gross total resection (GTR) was achieved on 71.4%. A total of 56.8% recurred after a median 29 mo (quartiles 10.5-45.5). The 36-mo survival rate was 83.5% (95% confidence interval [CI] 76.2-89.2%). Good functional outcomes (Glasgow Outcome Scale 4/5) were observed in 60.0%. The variables of interest were inconsistently reported and the multivariable analysis final sample was 133 patients. After adjustment for age, tumor size (each additional centimeter, hazard ratio [HR] 1.99, 95% CI 1.12-3.53, P = .019) and surgical treatment (HR 0.16, 95% CI 0.05-0.45, P = .001) were associated with 36-mo survival. CONCLUSION Tumor size and surgery are associated with improvement in 36-mo survival. We did not observe any significant benefits from GTR or adjuvant treatments.
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Affiliation(s)
- Vitor Nagai Yamaki
- Department of Neurosurgery, School of Medicine, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Renan Ribeiro Ribeiro
- Department of Pathology, School of Medicine, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Saul Almeida da Silva
- Department of Neurosurgery, School of Medicine, Universidade de Sao Paulo, Sao Paulo, Brazil
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Braun M, Tomasik B, Bieńkowski M, Wiśniewski K, Kupnicka DJ, Jaskólski D, Papierz W, Fijuth J, Kordek R. Recurrent Pineocytomalike Papillary Tumor of The Pineal Region: A Case Report and Literature Review. World Neurosurg 2018; 120:1-14. [PMID: 30165231 DOI: 10.1016/j.wneu.2018.08.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Papillary tumors of the pineal region (PTPRs) are malignant World Health Organization grade II/III tumors; however, they may perfectly mimic benign tumors (e.g., pineocytomas [World Health Organization grade I]). CASE DESCRIPTION We present a case of a 28-year-old man with a 35-mm tumor of the pineal region. Considering the typical radiological and pathologic presentation, the tumor was first diagnosed as pineocytoma. However, despite first total resection, the tumor recurred after 7 years. The recurrent neoplasm was composed mainly of papillary structures with low-grade atypical cells positive for CKAE1/AE3 and CK18. This categorization led to the final diagnosis of PTPR. The patient underwent adjuvant radiotherapy, which vastly improved his neurologic condition and resulted in significant tumor regression. CONCLUSIONS This case exemplifies that PTPRs can perfectly mimic pineocytomas and simple staining for cytokeratins may warrant correct diagnosis and better treatment.
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Affiliation(s)
- Marcin Braun
- Department of Pathology, Chair of Oncology, Medical University of Lodz, Lodz, Poland; Postgraduate School of Molecular Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Bartłomiej Tomasik
- Postgraduate School of Molecular Medicine, Medical University of Warsaw, Warsaw, Poland; Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland; Department of Radiation Oncology, Medical University of Lodz, Lodz, Poland
| | - Michał Bieńkowski
- Department of Pathomorphology, Medical University of Gdansk, Gdansk, Poland
| | - Karol Wiśniewski
- Department of Neurosurgery and Neurooncology, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | | | - Dariusz Jaskólski
- Department of Neurosurgery and Neurooncology, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Wielisław Papierz
- Department of Pathomorphology, Medical University of Lodz, Lodz, Poland
| | - Jacek Fijuth
- Department of Radiation Oncology, Medical University of Lodz, Lodz, Poland
| | - Radzislaw Kordek
- Department of Pathology, Chair of Oncology, Medical University of Lodz, Lodz, Poland
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Long-Term Follow-Up After Radiosurgery of Papillary Tumor of Pineal Region: 2 Case Reports and Review of Literature. World Neurosurg 2018; 116:190-193. [PMID: 29787881 DOI: 10.1016/j.wneu.2018.05.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Tumors of the pineal region are rare in adulthood, accounting for approximately 1% of intracranial neoplasms in this age range. Because of their rarity, it has proven to be difficult to establish the optimal therapy. Furthermore, microsurgical total resection in this eloquent location is associated with not low rates of morbidity. CASE DESCRIPTION We describe 2 patients diagnosed with papillary tumors of the pineal region by stereotactic biopsy and referred for Gamma Knife radiosurgery after shunting for hydrocephalus. We report a long-term follow-up of 15 and 20 years, respectively, showing a good response to the treatment. CONCLUSIONS After a diagnosis of papillary tumors of the pineal region, radiosurgery is an alternative treatment, with high local control and low morbidity.
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Papillary tumor of the pineal region with synchronous suprasellar focus and novel cytogenetic features. Hum Pathol 2015; 46:1232-6. [DOI: 10.1016/j.humpath.2015.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/24/2015] [Accepted: 04/21/2015] [Indexed: 11/19/2022]
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Koziarski A, Grala B, Skrobowska E. Papillary tumor of the pineal region. Report of two cases and literature review. Neurol Neurochir Pol 2014; 48:356-62. [PMID: 25440015 DOI: 10.1016/j.pjnns.2014.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/12/2014] [Accepted: 09/29/2014] [Indexed: 11/28/2022]
Abstract
Papillary tumor of the pineal region (PTPR) was introduced to the WHO classification in 2007. This rare tumor of little known natural history and unpredictable behavior was described in fewer than 100 cases. Its optimal treatment is not established yet. We report another two cases of PTPR in whom tumors were totally removed via supracerebellar infratentorial approach and both were treated with radiotherapy. In a 37-year-old man the operation was delayed 6 years after the first tumor diagnosis and subsequent shunt placement. He has no complaints 10 years after the onset of the disease. A 45-year-old woman has no complaints 24 months after surgery. Our experience and the data from literature indicate that a total tumor removal is the major prognostic factor.
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Affiliation(s)
- Andrzej Koziarski
- Department of Neurosurgery, Military Institute of Medicine, Warszawa, Poland.
| | - Bartłomiej Grala
- Department of Pathology, Military Institute of Medicine, Warszawa, Poland
| | - Ewa Skrobowska
- Department of Radiology, Military Institute of Medicine, Warszawa, Poland
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Fèvre Montange M, Vasiljevic A, Champier J, Jouvet A. Papillary tumor of the pineal region: Histopathological characterization and review of the literature. Neurochirurgie 2014; 61:138-42. [PMID: 24556386 DOI: 10.1016/j.neuchi.2013.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 04/26/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE The papillary tumor of the pineal region (PTPR) was described as a distinct new entity for the first time in 2003 by our team and has been included in the last 2007 WHO classification of tumors of the Central Nervous System. We describe the histopathological characterization of PTPR and present a review of the literature. METHODS The description of the histological and immunological features of PTPR is based on the 2007 WHO classification. RESULTS PTPR affects both children and adults, and mostly young adults in the third decade. PTPR is a neuroepithelial tumor occurring in the vicinity of the pineal gland, and characterized by its papillary architecture. The papillae are lined by multi-layered cuboidal to columnar epithelioid tumoral cells arranged in perivascular pseudorosettes. Immunohistochemistry shows strong reactivity for cytokeratins, particularly for cytokeratin 18. On electron microscopy, PTPR reveals ultrastructural features indicative of ependymal differentiation, including abundant microvilli at the apical cell pole. The differential diagnosis includes a variety of other papillary tumors, most notably papillary ependymoma, choroid plexus papilloma, papillary meningioma, and metastatic papillary carcinoma in adults. On the basis of ultrastructural and immunohistochemical features, it has been suggested that a PTPR arises from specialized cytokeratin-positive and nestin-positive ependymal cells that are derived from the subcommissural organ. Although the precise histological grading criteria of PTPR remain to be defined, its biological behavior may correspond to WHO grade II or III.
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Affiliation(s)
- M Fèvre Montange
- Équipe neuro-oncologie et neuro-inflammation, Inserm U1028, CNRS UMR5292, centre de recherche en neurosciences de Lyon, université Lyon 1, rue Paradin, 69372 Lyon cedex 08, France.
| | - A Vasiljevic
- Service de pathologie et de neuropathologie, centre de biologie et pathologie Est, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69500 Bron, France
| | - J Champier
- Équipe neuro-oncologie et neuro-inflammation, Inserm U1028, CNRS UMR5292, centre de recherche en neurosciences de Lyon, université Lyon 1, rue Paradin, 69372 Lyon cedex 08, France
| | - A Jouvet
- Équipe neuro-oncologie et neuro-inflammation, Inserm U1028, CNRS UMR5292, centre de recherche en neurosciences de Lyon, université Lyon 1, rue Paradin, 69372 Lyon cedex 08, France; Service de pathologie et de neuropathologie, centre de biologie et pathologie Est, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69500 Bron, France
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Fang AS, Meyers SP. Magnetic resonance imaging of pineal region tumours. Insights Imaging 2013; 4:369-82. [PMID: 23640020 PMCID: PMC3675249 DOI: 10.1007/s13244-013-0248-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 03/19/2013] [Accepted: 03/28/2013] [Indexed: 12/23/2022] Open
Abstract
Objectives Pineal lesions can present as a heterogeneous collection of benign and malignant disease conditions. Pineal lesions include germ cell tumours, neoplasms arising from the pineal parenchyma, as well as other pineal region masses. Methods A variety of cases of pineal lesions are presented. The important clinical features and typical imaging findings of each pineal lesion are described with emphasis on their morphological appearance and signal intensity characteristics on magnetic resonance imaging (MRI). Conclusion Knowledge of the imaging characteristics and clinical features of varying pineal lesions can assist in narrowing the differential diagnosis for more accurate and rational therapeutic planning. Teaching Points • Pineal parenchymal tumours show an “explosion” of normal pineal calcifications towards the periphery. • Pineoblastomas often have restricted diffusion, with apparent diffusion coefficient (ADC) values lower than germinomas. • Pineal teratomas and pineal lipomas display fat signal characteristics and fat saturation on MRI. • Pineal lesions in patients with known malignancy should raise suspicion of metastatic involvement. • Pineal cysts and arachnoid cysts show MRI signal characteristics similar to cerebrospinal fluid (CSF).
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Affiliation(s)
- Adam S Fang
- Department of Imaging Sciences, University of Rochester Medical Center School of Medicine and Dentistry, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA,
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Role of surgery, radiotherapy and chemotherapy in papillary tumors of the pineal region: a multicenter study. J Neurooncol 2013; 112:223-31. [PMID: 23314823 DOI: 10.1007/s11060-013-1050-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 12/29/2012] [Indexed: 10/27/2022]
Abstract
Papillary tumor of the pineal region (PTPR), recently described as a distinct clinicopathological entity, can show aggressive biological behavior. The optimal therapeutic approach of PTPR has not been well defined. The role of surgery, radiotherapy, and chemotherapy in the treatment of PTPR was analyzed in a large multicenter series. In order to determine factors that influence prognosis, outcome data of a series of 44 patients with histopathologically proven PTPR were retrospectively analyzed. Of the 44 patients, 32 were still alive after a median follow-up of 63.1 months. Twelve patients experienced progressive disease, with seven undergoing two relapses and five more than two. Median overall survival (OS) was not achieved. Median progression-free survival (PFS) was 58.1 months. Only gross total resection and younger age were associated with a longer OS, radiotherapy and chemotherapy having no significant impact. PFS was not influenced by gross total resection. Radiotherapy and chemotherapy had no significant effect. This retrospective series confirms the high risk of recurrence in PTPR and emphasizes the importance of gross total resection. However, our data provide no evidence for a role of adjuvant radiotherapy or chemotherapy in the treatment of PTPR.
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Histopathologic and Ultrastructural Features and Claudin Expression in Papillary Tumors of the Pineal Region. Am J Surg Pathol 2012; 36:916-28. [DOI: 10.1097/pas.0b013e31824b7114] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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El Majdoub F, Blau T, Hoevels M, Bührle C, Deckert M, Treuer H, Sturm V, Maarouf M. Papillary tumors of the pineal region: a novel therapeutic option-stereotactic 125iodine brachytherapy. J Neurooncol 2012; 109:99-104. [PMID: 22528796 DOI: 10.1007/s11060-012-0870-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 03/31/2012] [Indexed: 11/30/2022]
Abstract
We evaluated the efficacy of interstitial brachytherapy (IBT) using (125)Iodine ((125)I) seeds for treatment of papillary tumors of the pineal region. Between September 2003 and September 2010, four patients (M/F = 2/2; median age, 57.3 years; range 29.2-69.1 years) with papillary tumors of the pineal region underwent IBT using (125)I seeds. Before brachytherapy two patients underwent endoscopic ventriculo-cisternotomy, because of occlusive hydrocephalus, and subsequent microsurgical resection was performed on one; three patients were primarily treated with IBT. Median tumor volume was 3.3 ml (range 1.6-4 ml), the tumor surface dose ranged between 50 and 65 Gy. For three patients the seeds were implanted permanently whereas one patient received temporary implants (28 days). The median follow-up time was 53.6 months (range 13-103.4 months). After brachytherapy, follow-up MR images revealed complete remission in one patient, partial remission in two, and stable disease in the remaining patient. Neurological status improved in all patients (reduced headache and nausea/vomiting for four patients; improvement of oculomotor dysfunction for two of three patients partially and for one of three patients completely). Neither treatment-related morbidity nor mortality was observed. Our results are indicative of good local control of papillary tumors of the pineal region after IBT, without treatment-related morbidity.
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Affiliation(s)
- Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Kerpenerstrasse 62, 50937, Cologne, Germany.
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Complete regression of papillary tumor of the pineal region after radiation therapy: case report and review of the literature. J Neurooncol 2011; 107:427-34. [PMID: 22086239 DOI: 10.1007/s11060-011-0764-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 11/08/2011] [Indexed: 10/15/2022]
Abstract
Papillary tumor of the pineal region (PTPR) is a rare neuroepithelial tumor that arises in the pineal region. The optimal treatment for PTPR remains controversial, as no definitive treatment strategy exists for this lesion. It is not clear whether aggressive surgical removal is superior to biopsy followed by radiotherapy. The majority of cases in the literature have undergone attempted gross total resection with a supracerebellar-infratentorial or a transcallosal-transventricular approach. In this report, we describe a case of PTPR in a 23 year-old male that presented as a third ventricular mass causing obstructive hydrocephalus. An endoscopic third ventriculostomy was performed followed by an endoscopic biopsy. Postoperative radiotherapy resulted in complete regression of the tumor with no evidence of tumor recurrence at 25 months. This case highlights a minimally invasive strategy for a rare neoplasm that resulted in a favorable response to radiation therapy, thereby avoiding the risks of aggressive surgical removal. We also review the radiographic and histopathologic features of PTPR and discuss various options of treatment reported in the literature.
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Lechapt-Zalcman E, Chapon F, Guillamo JS, Khouri S, Menegalli-Boggelli D, Loussouarn D, Fevre-Montange M, Jouvet A. Scientific correspondence. Neuropathol Appl Neurobiol 2011; 37:431-5. [DOI: 10.1111/j.1365-2990.2010.01133.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Poulgrain K, Gurgo R, Winter C, Ong B, Lau Q. Papillary tumour of the pineal region. J Clin Neurosci 2011; 18:1007-17. [PMID: 21658955 DOI: 10.1016/j.jocn.2010.12.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 12/15/2010] [Accepted: 12/19/2010] [Indexed: 11/18/2022]
Abstract
Papillary tumour of the pineal region (PTRR) is one of the new tumour entities to be included in the latest World Health Organization classification of central nervous system tumours. We report two illustrative patients, a 25-year-old female who presented following a head injury sustained from a fall due to gait disturbances, and a 42-year-old man who presented with headaches. Histology of both cases showed distinct papillary growth patterns with lining of the papillae by multi-layered cuboidal to columnar cells, prominent perivascular rosette and focal true rosette formation. Immunohistochemistry exhibited strong cytokeratin immunoreactivity in addition to CD56, focal S100, glial fibrillary acidic protein and neuron specific enolase positivity which supported a diagnosis of PTPR in both patients. Postoperatively, both patients underwent courses of adjuvant radiation therapy. One patient reported local recurrence of the tumour 23 months after surgery. While PTPR may have been misdiagnosed in the past, clear and consistent characteristics are beginning to be elucidated in the published reports and literature, which have been reviewed. As a relatively new distinct clinicopathological entity, prognostic data are limited and guidelines for treatment protocols are still being investigated in view of its propensity for local recurrence.
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Affiliation(s)
- Katherine Poulgrain
- School of Medicine, University of Queensland, St. Lucia, Queensland, Australia
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Júnior GV, Dellaretti M, de Carvalho GTC, Brandão RACS, Mafra A, de Sousa AA. Papillary tumor of the pineal region. Brain Tumor Pathol 2011; 28:329-34. [DOI: 10.1007/s10014-011-0040-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
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18
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Gutenberg A, Brandis A, Hong B, Gunawan B, Enders C, Schaefer IM, Burger R, Ostertag H, Gaab M, Krauss JK, Füzesi L. Common molecular cytogenetic pathway in papillary tumors of the pineal region (PTPR). Brain Pathol 2011; 21:672-7. [PMID: 21470326 DOI: 10.1111/j.1750-3639.2011.00493.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Primary papillary tumors of the central nervous system and particularly the pineal region are rare. Papillary tumor of the pineal region (PTPR) is a recently described neoplasm that has been formally recognized in the 2007 World Health Organization Classification of Tumors of the Nervous System. Because of their rarity, further pheno- and genotypical observations as well as therapeutic experience are necessary to differentiate PTPR from other primary or secondary papillary tumors of this region. We herein present three cases of PTPR characterized by local recurrence in two of them. Primary and recurrent tumors were analyzed by immunohistochemistry and comparative genomic hybridization (CGH). From our results clonal chromosomal aberrations can be postulated which seem to be a feasible tool to differentiate PTPRs from other primary or secondary papillary tumors of this region.
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Affiliation(s)
- Angelika Gutenberg
- Departments of Neurosurgery Pathology, Georg August University Göttingen, Germany.
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Smith AB, Rushing EJ, Smirniotopoulos JG. From the archives of the AFIP: lesions of the pineal region: radiologic-pathologic correlation. Radiographics 2011; 30:2001-20. [PMID: 21057132 DOI: 10.1148/rg.307105131] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lesions of the pineal region include a diverse group of entities. The most common neoplastic lesions are the germ cell tumors. Germ cell tumors may be hormonally active, and evaluation of serum or cerebrospinal fluid levels of oncoproteins assists in making the diagnosis. Neoplasms arising from the pineal parenchyma include the low-grade pineocytoma, pineal parenchymal tumor of intermediate differentiation, and the highly malignant pineoblastoma. Germ cell tumors and pineal parenchymal neoplasms do not have pathognomonic imaging findings, but imaging in combination with laboratory evaluation helps narrow the differential diagnosis. Neoplasms may also arise from the variety of cell types residing in the proximity of the pineal gland. These include lipomas, meningiomas, and astrocytomas. Congenital lesions such as epidermoid and dermoid cysts and lipomas can also occur. Knowledge of the variety of lesions that occur in the pineal region, their imaging appearances, and their clinical features assists in narrowing the radiologic differential diagnosis and optimizing patient treatment.
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Affiliation(s)
- Alice Boyd Smith
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC, USA.
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Kim YH, Kim JW, Park CK, Kim DG, Sohn CH, Chang KH, Park SH. Papillary tumor of pineal region presenting with leptomeningeal seeding. Neuropathology 2011; 30:654-60. [PMID: 20374498 DOI: 10.1111/j.1440-1789.2010.01108.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Papillary tumor of the pineal region (PTPR) is a recently recognized and rare pineal tumor, presenting as a solitary mass with or without hydrocephalus. Here, we report a case of c-Kit expressing PTPR with leptomeningeal seeding. A 39-year-old woman presented with a 1-month history of headache and decreased visual acuity. MRI showed a large, 4 cm-diameter solid and cystic enhancing mass at the pineal region with associated ventriculomegaly. Smaller nodular lesions were also found at the pituitary stalk and bilateral internal acoustic canal (IAC). The leptomeninges were noted to be enhanced with gadolinium. Endoscopic third ventriculostomy and partial resection were performed. The specimen was small in quantity but nonetheless, revealed the typical features of PTPR, which were tumor cells with vacuolated cytoplasm forming a pseudopapillary architecture. The tumor cells were diffusely immunoreactive for vimentin, INI-1 and c-Kit, focally immunoreactive for neuronal specific enolase (NSE) and S100 protein but negative for cytokeratin, epithelial membrane antigen (EMA), synaptophysin and GFAP. Ultrastructurally, the tumor cells revealed variably-sized cytoplasmic vacuoles, intermediate filaments and villous cytoplasmic membrane. With these features, a diagnosis of PTPR was rendered. The lesions at the pineal gland and bilateral IAC were irradiated through gamma knife radiosurgery and a decrease in size of the lesions was noted on follow-up MRI. However, soon after, other lesions were also noted to develop along the adjacent sites. The case presented is proof that PTPR can disseminate to other sites distant from the original lesion. This case was a c-kit expressing PTPR, which might represent the more primitive nature of this tumor. Ultrastructural examination is useful to differentiate PTPR from other tumors of the pineal gland in addition to immunohistochemistry.
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Affiliation(s)
- Yong Hwy Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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21
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Abstract
Pineal tumors are a rare and heterogeneous group of primary central nervous system neoplasms, including pineal parenchymal tumors (pineocytomas, pineal parenchymal tumors of intermediate differentiation, and pineoblastomas), germ cell tumors, and neuroepithelial tumors, such as astrocytomas, ependymomas, and papillary tumor of the pineal region. Their classification has evolved over time, with several updates incorporated into the most recent World Health Organization classification, published in 2007. This review highlights the most recent classification and grading scheme for pineal parenchymal tumors and discusses the newly recognized papillary tumor of the pineal region, including clinicopathologic features, differential diagnosis, and management options.
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Fèvre-Montange M, Vasiljevic A, Champier J, Jouvet A. Histopathology of tumors of the pineal region. Future Oncol 2010; 6:791-809. [PMID: 20465391 DOI: 10.2217/fon.10.28] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pineal region tumors are heterogeneous lesions and include mainly pineal parenchymal tumors (PPTs), papillary tumors of the pineal region (PTPRs) and germ cell tumors (GCTs). This article describes the cystic pineal gland compared with normal tissue and histopathological features of the most frequent pineal region tumors. PPTs are subdivided into pineocytoma (grade I), pineoblastoma (grade IV) and tumors with intermediate differentiation (PPTIDs; grades II-III). A grading system based on the number of mitoses and neurofilament protein expression distinguishes low- from high-grade PPTID. PTPR is a new tumoral entity thought to originate from the subcommissural organ. GCTs include germinoma, embryonal carcinoma, teratoma, yolk sac tumor and choriocarcinoma and are often of mixed histologic composition. New histogenetic data for GCTs are presented.
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Affiliation(s)
- Michelle Fèvre-Montange
- National Institute of Health & Medical Research (INSERM) U842, University of Lyon, Faculty of Medicine, RTH Laennec, Lyon Cedex 08, France.
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Cunliffe CH, Fischer I, Parag Y, Fowkes ME. State-of-the-Art Pathology: New WHO Classification, Implications, and New Developments. Neuroimaging Clin N Am 2010; 20:259-71. [DOI: 10.1016/j.nic.2010.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Murali R, Scheithauer BW, Chaseling RW, Owler BK, Ng T. Papillary tumour of the pineal region: cytological features and implications for intraoperative diagnosis. Pathology 2010; 42:474-9. [DOI: 10.3109/00313025.2010.494292] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kaloshi G, Rroji A, Lame A, Leka L, Haxhihyseni E, Vreto G, Petrela M. Natural history of papillary tumor of the pineal region: new insights on biological explanation. J Neurooncol 2010; 100:487-8. [PMID: 20454919 DOI: 10.1007/s11060-010-0198-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 04/13/2010] [Indexed: 11/30/2022]
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26
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Dulai MS, Caccamo DV, Briley AL, Edwards MSB, Fisher PG, Lehman NL. Intramedullary papillary ependymoma with choroid plexus differentiation and cerebrospinal fluid dissemination to the brain. J Neurosurg Pediatr 2010; 5:511-7. [PMID: 20433266 DOI: 10.3171/2009.12.peds09130] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This 8-year-old girl presented with a papillary ependymoma in the thoracic spinal cord. Resection was followed by recurrence at the primary site and later in the lumbosacral thecal sac, followed by cerebrospinal fluid dissemination to the brain approximately 5 years after her initial presentation. The tumor showed cytological and immunohistochemical features overlapping those of classic ependymomas and choroid plexus tumors similar to those seen in uncommon supratentorial papillary ependymomas, also known as papillary tumors of the pineal region. The histopathological and clinical courses of this rare spinal papillary ependymoma exhibiting mixed ependymal and choroid plexus-like differentiation are discussed.
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Affiliation(s)
- Mohanpal S Dulai
- Department of Pathology, Stanford University Medical Center, Stanford, California, USA
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Cerase A, Vallone IM, Di Pietro G, Oliveri G, Miracco C, Venturi C. Neuroradiological follow-up of the growth of papillary tumor of the pineal region: a case report. J Neurooncol 2009; 95:433-435. [PMID: 19517065 DOI: 10.1007/s11060-009-9931-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 05/24/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Alfonso Cerase
- Unit of Neuroimaging and Neurointervention, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, Viale Mario Bracci, 16-53100, Siena, Italy.
- Interdepartmental Center of Nuclear Magnetic Resonance, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, Viale Mario Bracci, 16-53100, Siena, Italy.
| | - Ignazio Maria Vallone
- Unit of Neuroimaging and Neurointervention, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, Viale Mario Bracci, 16-53100, Siena, Italy
- Interdepartmental Center of Nuclear Magnetic Resonance, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, Viale Mario Bracci, 16-53100, Siena, Italy
| | - Giovanni Di Pietro
- Unit of Neurosurgery, Department of Neurosciences, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, Viale Mario Bracci, 16-53100, Siena, Italy
| | - Giuseppe Oliveri
- Unit of Neurosurgery, Department of Neurosciences, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, Viale Mario Bracci, 16-53100, Siena, Italy
| | - Clelia Miracco
- Department of Human Pathology, Section of Pathologic Anatomy, University of Siena, "Santa Maria alle Scotte" General Hospital, Viale Mario Bracci, 16-53100, Siena, Italy
| | - Carlo Venturi
- Unit of Neuroimaging and Neurointervention, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, Viale Mario Bracci, 16-53100, Siena, Italy
- Interdepartmental Center of Nuclear Magnetic Resonance, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, Viale Mario Bracci, 16-53100, Siena, Italy
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