Papillary tumor of the pineal region

Papillary tumor of the pineal region in pediatric patient – A case report

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.

Papillary tumor of the pineal region in pediatric populations: An additional case and systematic review of a rare tumor entity

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.

Papillary Tumor of the Pineal Region: Systematic Review and Analysis of Prognostic Factors

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.

Recurrent Pineocytomalike Papillary Tumor of The Pineal Region: A Case Report and Literature Review

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.

Papillary tumor of the pineal region: A case report and review of the literature

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.

Papillary tumor of the pineal region: Histopathological characterization and review of the literature

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.

Pediatric papillary tumors of the pineal region: to observe or to treat following gross total resection?

INTRODUCTION

Papillary tumors of the pineal region (PTPR) are rare brain tumors characterized by frequent local recurrences. Standardized treatment strategies are not yet defined.

CASE REPORT

We present the case of a 3-year-old girl diagnosed with PTPR. Due to her young age, adjuvant radiotherapy was omitted after gross total tumor resection. Thirty-six months later, local tumor recurrence occurred. Considering the possible risks of secondary surgery, the recurrent tumor was irradiated with proton radiotherapy. Three months later, the tumor showed near-complete remission.

DISCUSSION

Based on this experience and other pediatric case reports from the literature, local radiotherapy might be suggested also after complete tumor resection.

Role of surgery, radiotherapy and chemotherapy in papillary tumors of the pineal region: a multicenter study

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.

Papillary tumor of the pineal region: a case involving isocitrate dehydrogenase (IDH) genotyping

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.