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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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Pleomorphic Xanthoastrocytoma of the Pineal Region in a Pediatric Patient With Neurofibromatosis Type 1. Ochsner J 2020; 20:226-231. [PMID: 32612482 PMCID: PMC7310189 DOI: 10.31486/toj.18.0156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Pleomorphic xanthoastrocytoma (PXA) is a rare and often focal glioma that most commonly affects children and young adults. Lesions are preferentially supratentorial and superficial, although infratentorial masses have been described, along with occasional involvement of the leptomeninges. The World Health Organization (WHO) categorizes these tumors as grade II, with surgical resection carrying a favorable prognosis. However, these tumors may undergo malignant degeneration and must be identified for appropriate treatment and prognosis. PXA has been associated with neurofibromatosis type 1 (NF1), although it is not the classic phenotype of NF1. We present a novel report of PXA, atypically located in the pineal region of a patient with a history of NF1. Case Report: A 17-year-old male with a history of NF1 presented with 1 month of bifrontal headaches. Magnetic resonance imaging was significant for a heterogeneous tectal mass, suspicious for a glioma extending to the fourth ventricle and causing displacement of the cerebral aqueduct without obstructive hydrocephalus. Following an infratentorial-supracerebellar approach for tumor resection, histopathology confirmed a low-grade variable neoplasm consistent with PXA. Postoperative imaging confirmed gross total resection with no evidence of recurrence at 9 months postoperatively. Conclusion: To our knowledge, this case is the fifth report of pineal PXA and the first associated with NF1. Because PXA presents similarly to other NF1-related intracranial tumors, careful diagnosis via immunohistochemistry is imperative. Gross tumor resection is usually curative; however, PXA has the propensity to undergo malignant degeneration and may require adjuvant treatment.
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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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Lancia A, Becherini C, Detti B, Bottero M, Baki M, Cancelli A, Ferlosio A, Scoccianti S, Sun R, Livi L, Ingrosso G. Radiotherapy for papillary tumor of the pineal region: A systematic review of the literature. Clin Neurol Neurosurg 2019; 190:105646. [PMID: 31896492 DOI: 10.1016/j.clineuro.2019.105646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/10/2019] [Accepted: 12/19/2019] [Indexed: 11/29/2022]
Abstract
Papillary tumor of the pineal region (PTPR) is a rare neuroepithelial brain tumor, characterized by a high risk of local recurrence (greater than 70 % at 6 years). The aim of our study was to review the available literature on radiotherapy for PTPR in order to evaluate timings, schedules, outcomes and toxicities of this treatment modality. In our review, 72.4 % (84) of the patients diagnosed with PTPR received radiation therapy. There is heterogeneity in the dose prescription, ranging from 45 Gy (25 × 1.8 Gy) to 60 Gy (30 × 2 Gy) for 3D Conformal Radiation Therapy and from 12 Gy to 36 Gy for Stereotactic Radiosurgery. Being considered as a grade II or III tumor, PTPR should receive higher total radiation dose in the adjuvant setting. Our analysis showed a very limited treatment-related toxicity with an expected 10-y OS of 72.5 %. At 5-years from the diagnosis, about 60 % of the patients experienced a local recurrence, whereas at 10 years the rate is higher than 80 %. In the literature, conflicting data about radiotherapy for PTPR are reported, in particular regarding disease progression. Although radiotherapy represents a fundamental treatment in the management of PTPR, prospective studies are required to better define its impact on overall survival and progression-free survival.
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Affiliation(s)
- Andrea Lancia
- Radiation Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | - Beatrice Detti
- Radiotherapy Unit, Department of Oncology, AOU Careggi, Florence, Italy.
| | - Marta Bottero
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Muhammed Baki
- Radiotherapy Unit, Department of Oncology, AOU Careggi, Florence, Italy
| | - Alessandro Cancelli
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Amedeo Ferlosio
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Silvia Scoccianti
- Radiotherapy Unit, Department of Oncology, AOU Careggi, Florence, Italy
| | - Roger Sun
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 94800, Villejuif, France
| | - Lorenzo Livi
- Radiotherapy Unit, Department of Oncology, AOU Careggi, Florence, Italy
| | - Gianluca Ingrosso
- Radioterapia Oncologica, Dipartimento di Scienze Chirurgiche e Biomediche, Università degli Studi di Perugia, ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy
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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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Hua X, Yang P, Zhang M, Zhao Y, Wang B. Papillary tumor of the pineal region: A case report and review of the literature. Exp Ther Med 2015; 10:1375-1379. [PMID: 26622493 PMCID: PMC4578110 DOI: 10.3892/etm.2015.2696] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/14/2015] [Indexed: 11/06/2022] Open
Abstract
Papillary tumor of the pineal region (PTPR) was first described as a distinct tumor entity in 2003 and was introduced into the World Health Organization classification of central nervous system tumors in 2007. This tumor is rare and, to the best of our knowledge, only 7 cases have been reported in children <16 years of age, while the youngest documented patient was a 15-month-old boy. The present study reported a case of PTPR in a 10-year-old girl who underwent magnetic resonance imaging and surgical resection of tumors. Histological and immunohistochemical staining results were presented. Patients with PTPR require long-term follow-up, and the patient of the present study has continued to do well, with no recurrence of the tumor at the 15-month follow-up examination. In addition, a review of the literature on this unusual neoplasm was performed, along with discussion of their differential diagnosis.
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Affiliation(s)
- Xiaomin Hua
- Department of Microbiology, Qingdao University Medical College, Qingdao, Shandong 266071, P.R. China
| | - Ping Yang
- Department of Pathology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Ming Zhang
- Department of Anatomy, Qingdao University Medical College, Qingdao, Shandong 266071, P.R. China
| | - Yudan Zhao
- Department of Microbiology, Qingdao University Medical College, Qingdao, Shandong 266071, P.R. China
| | - Bin Wang
- Department of Microbiology, Qingdao University Medical College, Qingdao, Shandong 266071, P.R. China
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Sasani M, Solmaz B, Oktenoglu T, Ozer AF. An unusual location for a choroid plexus papilloma: the pineal region. Childs Nerv Syst 2014; 30:1307-11. [PMID: 24442139 DOI: 10.1007/s00381-014-2361-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Choroid plexus papillomas (CPP) are rare benign neoplasms of the central nervous system that occur most often in children during the first decade of life. They occur most often in the lateral ventricle. It is extremely rare for a CPP to occur in the pineal region. We describe the case of a child with a CPP located in the pineal region, who was initially diagnosed with obstructive hydrocephalus by cranial computed tomography (CT). METHODS A 9-year-old female patient presented with complaints of visual disturbance, nausea, and vomiting. Magnetic resonance imaging (MRI) showed a poor contrast-enhanced pineal-localized lesion. Anatomical variations within the patient caused her surgery to proceed using a supratentorial-occipital interhemispheric approach. RESULTS The tumor was totally removed, and a histological examination revealed the tumor to be a typical CPP. The patient received follow-up neurological and ophthalmologic examinations at 3, 6, 9, 12, 24, and 36 months postoperatively, which demonstrated her progressive improvement. CONCLUSIONS CPPs may have a wide range of locations and resulting symptoms. However, the pineal region is a rarely encountered location, particularly for pediatric patients. It is of great value to correctly differentiate neoplasms such as germ cell tumors, pineocytomas, meningiomas, and astrocytomas, so that patients receive the correct diagnosis and treatment approach.
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Affiliation(s)
- Mehdi Sasani
- Neurosurgery Department, American Hospital, Guzelbahce Sk. No: 20, 34365, Nisantasi, Istanbul, Turkey,
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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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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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12
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Papillary tumor of the pineal region: a case involving isocitrate dehydrogenase (IDH) genotyping. Brain Tumor Pathol 2012; 30:45-9. [PMID: 22466620 DOI: 10.1007/s10014-012-0098-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
Abstract
Papillary tumor of the pineal region (PTPR) is a recently described neoplasm. Several studies have been published on this tumor, but its pathological features and the appropriate treatment remain unclear. PTPR is reported to originate from ependymal cells in the subcommissural organ. Isocitrate dehydrogenase 1 and 2 (IDH1/2) mutations have been a focus area in glioma research as promising predictors. We report a case of PTPR that was characterized by local recurrence, although subtotal removal and radiotherapy seemed effective for many months. Histological examination showed ependymal features in the surgical specimens. As far as we are aware, this case study is the first to show that the IDH1/2 genotypes in PTPR cells are wild-type genotypes, which is consistent with the negative immunoreactivity that was observed for the IDH1 mutant antibody in this study.
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13
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Wong YS, Chan AWH, Ng HK, Chan DTM, Ng DWK, Siu DYW, Tang P, Poon WS. 45 year old man with a pineal region tumor for over 15 years. Brain Pathol 2012; 22:255-8. [PMID: 22369107 DOI: 10.1111/j.1750-3639.2012.00570.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Yuen Shan Wong
- Chinese University of Hong Kong Brain Tumor Centre, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Dumrongpisutikul N, Intrapiromkul J, Yousem DM. Distinguishing between germinomas and pineal cell tumors on MR imaging. AJNR Am J Neuroradiol 2011; 33:550-5. [PMID: 22173760 DOI: 10.3174/ajnr.a2806] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Tumors of pineal cell origin have different prognosis and treatment than those of germ cell origin. The recent literature suggests that these tumors often look alike. Our study aimed to differentiate between pineal cell tumor and germinoma based on ADC values, the homogeneity of the mass, and MR imaging characteristics. MATERIALS AND METHODS We enrolled 20 patients who had pretreatment MR imaging scans with histologic verification of tumors of pineal cell origin and germinomas. The tumors were measured for the ADC values and for homogeneity by the coefficient of variation of ADC values, and T1WI and T2WI signal intensity values. RESULTS The 20 subjects (8 females and 12 males) ranged in age from 1.5-64.9 years, with a mean age of 23.9 years (SD 17.7 years). The mean age of those with germinomas was 13.7 years (SD 3.8 years), less than the mean of 29.4 years for those with pineal cell tumors (SD 19.9 years; P = .016). These 2 groups showed no significant difference in coefficients of variation on T1WI, T2WI, and ADC images. However, germinomas showed statistically significant higher ADC values (mean 1590.69 ± 532.96 × 10(-6) mm(2)/s) than pineal cell tumors (mean 883.58 ± 317.48 × 10(-6) mm(2)/s; P = .02). An accuracy of 89.5%, sensitivity of 83.3%, specificity of 92.3%, PPV of 83.3%, and NPV of 92.3% were yielded for an ADC threshold of 1250.00 × 10(-6) mm(2)/s. CONCLUSIONS Germinomas showed higher ADC values than the pineal cell tumors (P = .02), and the patients were younger. Otherwise, there were no definitive imaging characteristics that distinguished pineal cell tumors from germinomas.
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Affiliation(s)
- N Dumrongpisutikul
- Department of Radiology, The Johns Hopkins Medical Institution, Baltimore, Maryland 21287, USA
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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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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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Li J, Recinos PF, Orr BA, Burger PC, Jallo GI, Recinos VR. Papillary tumor of the pineal region in a 15-month-old boy. J Neurosurg Pediatr 2011; 7:534-8. [PMID: 21529195 PMCID: PMC4612618 DOI: 10.3171/2011.2.peds10434] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The papillary tumor of the pineal region (PTPR) is a distinct entity that is particularly rare in the pediatric population. The authors document the youngest reported patient with this clinicopathological entity to date. A case of PTPR in a 15-month-old boy is described. Initially thought to be a tectal glioma, the tumor was later identified as a pineal region tumor after demonstrating growth on routine imaging. Diagnosis of PTPR was established by histopathological evaluation of biopsy samples, which revealed papillary, cystic, and solid tumor components. The patient's postoperative course was complicated by tumor growth despite several debulking procedures and chemotherapy, as well as persistent hydrocephalus requiring 2 endoscopic third ventriculostomies and eventual ventriculoperitoneal shunt placement. After a 15-month follow-up period, the patient has received proton-beam therapy and has a stable tumor size. The PTPR is a recently described tumor of the CNS that must be included in the differential diagnosis of pineal region masses. The biological behavior, prognosis, and appropriate treatment of PTPR have yet to be fully defined.
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Affiliation(s)
- Jessica Li
- Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pablo F. Recinos
- Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Brent A. Orr
- Division of Neuropathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter C. Burger
- Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland,Division of Neuropathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George I. Jallo
- Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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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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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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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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24
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Williams JM, Michal U, Botteron C, Skerritt G, Hetzel U. Papillary Tumor of the Pineal Region of a Dog. J Vet Diagn Invest 2009; 21:910-4. [DOI: 10.1177/104063870902100628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 3-year-old, intact, male Beagle dog developed clinical signs of pleurothotonus and altered head position to the right, neck pain, nystagmus, hyperreflexia of the left forelimb, and hyperextension of both forelimbs. Magnetic resonance imaging enabled a tentative diagnosis of thalamic neoplasia with incidental hydromyelia at the level of the second cervical vertebra. The animal was euthanatized due to the poor prognosis, and a necropsy was performed. A large, well-demarcated, nonencapsulated, and focally infiltrative mass was present in the approximate location of, and effacing, the pineal gland. The mass was composed of densely packed polyhedral neoplastic cells that exhibited epithelial characteristics, such as intercellular junctions, and contained carbohydrate granules and occasionally melanin granules. Immunohistology confirmed that neoplastic cells expressed neuron-specific enolase and, in a small proportion, cytokeratin. These combined findings led to the diagnosis of a papillary tumor of the pineal region, a tumor not previously described in dogs.
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Affiliation(s)
- Jonathan M. Williams
- Department of Veterinary Pathology, Faculty of Veterinary Science, University of Liverpool, Liverpool, UK
| | | | - Catherine Botteron
- Department of Veterinary Pathology, Faculty of Veterinary Science, University of Liverpool, Liverpool, UK
| | | | - Udo Hetzel
- Department of Veterinary Pathology, Faculty of Veterinary Science, University of Liverpool, Liverpool, UK
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Nakamura H, Makino K, Kochi M, Nakazato Y, Kuratsu JI. Successful treatment of neoadjuvant therapy for papillary tumor of the pineal region. Brain Tumor Pathol 2009; 26:73-7. [PMID: 19856218 DOI: 10.1007/s10014-009-0250-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 03/09/2009] [Indexed: 11/30/2022]
Abstract
We report a boy who in 1994, at the age of 11, presented with headache and vomiting. The fi nal diagnosis was papillary tumor of the pineal region (PTPR). Magnetic resonance imaging (MRI) revealed a heterogeneous mass. Hydrocephalus was addressed by immediate ventricle drainage; subsequently, we attempted tumor removal. As the intraoperative diagnosis of the hemorrhagic tumor was primitive neuroectodermal tumor (PNET), we did not proceed to total removal. After the delivery of radiotherapy (50.4 Gy) and one course of Nimustine hydrochloride (ACNU) chemotherapy, the residual tumor was completely resected. The diagnosis at that time (1994) was papillary pineocytoma. He was followed on an outpatient basis for 15 years and remained free of recurrence. This type of tumor was later proposed to represent a new distinct tumor subtype, papillary tumor of the pineal region (PTPR). Our data indicate that our patient's tumor should be included in this category.
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Affiliation(s)
- Hideo Nakamura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-Honjo, Kumamoto, 860-8556, Japan.
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Clinicopathological features from long-term observation of a papillary tumor of the pineal region (PTPR): a case report. Brain Tumor Pathol 2009; 26:83-8. [DOI: 10.1007/s10014-009-0246-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 02/20/2009] [Indexed: 10/20/2022]
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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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