1
|
Yamashita S, Takeshima H, Hata N, Uchida H, Shinojima N, Yokogami K, Nakano Y, Sakata K, Fudaba H, Enomoto T, Nakahara Y, Ujifuku K, Sugawara K, Iwaki T, Sangatsuda Y, Yoshimoto K, Hanaya R, Mukasa A, Suzuki K, Yamamoto J, Negoto T, Nakamura H, Momii Y, Fujiki M, Abe H, Masuoka J, Abe T, Matsuo T, Ishiuchi S. Clinicopathologic analysis of pineal parenchymal tumors of intermediate differentiation: a multi-institutional cohort study by the Kyushu Neuro-Oncology Study Group. J Neurooncol 2023; 162:425-433. [PMID: 37052748 DOI: 10.1007/s11060-023-04310-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Pineal parenchymal tumors of intermediate differentiation (PPTIDs), which were recognized in the 2007 World Health Organization (WHO) classification, are rare, accounting for less than 1% of all central nervous system tumors. This rarity and novelty complicate the diagnosis and treatments of PPTID. We therefore aimed to evaluate the clinicopathological significance of this tumor. METHODS At 11 institutions participating in the Kyushu Neuro-Oncology Study Group, data for patients diagnosed with PPTID were collected. Central pathology review and KBTBD4 mutation analysis were applied to attain the diagnostically accurate cohort. RESULTS PPTID was officially diagnosed in 28 patients: 11 (39%) with WHO grade 2 and 17 (61%) with WHO grade 3 tumors. Median age was 49 years, and the male:female ratio was 1:2.1. Surgery was attempted in all 28 patients, and gross total resection (GTR) was achieved in 46% (13/28). Adjuvant radiotherapy and chemotherapy were administered to, respectively, 82% (23/28) and 46% (13/28). The 5-year progression-free survival (PFS) and overall survival rates were 64.9% and 70.4% respectively. Female sex (p = 0.018) and GTR (p < 0.01) were found to be independent prognostic factors for PFS and female sex (p = 0.019) was that for OS. Initial and second recurrences were most often leptomeningeal (67% and 100% respectively). 80% (20/25) of patients harbored a KBTBD4 mutation. CONCLUSIONS Female sex and GTR were independent prognostic factors in our patients with PPTID. Leptomeningeal recurrence was observed to be particularly characteristic of this tumor. The rate of KBTBD4 mutation observed in our cohort was acceptable and this could prove the accuracy of our PPTID cohort.
Collapse
Affiliation(s)
- Shinji Yamashita
- Division of Neurosurgery, Department of Clinical Neuroscience, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Hideo Takeshima
- Division of Neurosurgery, Department of Clinical Neuroscience, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Nobuhiro Hata
- Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - Hiroyuki Uchida
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Naoki Shinojima
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kiyotaka Yokogami
- Division of Neurosurgery, Department of Clinical Neuroscience, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yoshiteru Nakano
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kiyohiko Sakata
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Hirotaka Fudaba
- Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - Toshiyuki Enomoto
- Department of Neurosurgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yukiko Nakahara
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kenta Ujifuku
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kenichi Sugawara
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tooru Iwaki
- Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyusyu University, Fukuoka, Japan
| | - Yuhei Sangatsuda
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryousuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kohei Suzuki
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Junkoh Yamamoto
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tetsuya Negoto
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Hideo Nakamura
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Yasutomo Momii
- Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - Minoru Fujiki
- Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Jun Masuoka
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tatsuya Abe
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shogo Ishiuchi
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| |
Collapse
|
2
|
Kato H, Tanei T, Nishimura Y, Nagashima Y, Ishii M, Nishii T, Fukaya N, Abe T, Saito R. Pineal parenchymal tumor of intermediate differentiation with late spinal dissemination 13 years after initial surgery: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22475. [PMID: 36794736 PMCID: PMC10550595 DOI: 10.3171/case22475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/12/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Pineal parenchymal tumors of intermediate differentiation (PPTIDs) are rare in the pineal gland. A case of PPTID that disseminated to the lumbosacral spine 13 years after the total resection of a primary intracranial tumor has been reported. OBSERVATIONS A 14-year-old female presented with headache and diplopia. Magnetic resonance imaging revealed a pineal tumor that induced obstructive hydrocephalus. A biopsy and endoscopic third ventriculostomy were performed. Histological diagnosis revealed a grade II PPTID. Two months later, the tumor was removed via craniotomy because the postoperative Gamma Knife surgery was ineffective. Histological diagnosis confirmed PPTID, although the grade was revised from II to III. Postoperative adjuvant therapy was not performed, because the lesion had been irradiated and gross total tumor removal was achieved. She has had no recurrence in 13 years. However, pain around the anus newly appeared. Magnetic resonance imaging of the spine revealed a solid lesion in the lumbosacral spine. The lesion was subtotally resected, and histological diagnosis revealed grade III PPTID. Postoperative radiotherapy was performed, and she had no recurrence 1 year after radiotherapy. LESSONS Remote dissemination of PPTID can occur several years after the initial resection. Regular follow-up imaging, including the spinal region, should be encouraged.
Collapse
|
3
|
Liu C, Carmicheal J, Baine MJ, Zhang C. Radiation therapy for pineal parenchymal tumor of intermediate differentiation: A case series and literature review. J Cent Nerv Syst Dis 2023; 15:11795735231160036. [PMID: 36949932 PMCID: PMC10026104 DOI: 10.1177/11795735231160036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/09/2023] [Indexed: 03/18/2023] Open
Abstract
Pineal parenchymal tumor of intermediate differentiation (PPTID) is a rare, primary tumor of the pineal gland. Due to its rarity, there is no consensus on optimal therapeutic strategies or standard characterization of the tumor's behavior. Here, we report 2 new cases of PPTID and an extensive review of the literature involving the use and extent of radiation therapy. Patient 1 is a 54-year-old male who presented with PPTID and drop metastases in the spinal cord, received cranial spinal irradiation (CSI), and experienced recurrence 3.5 years after treatment. Stereotactic body radiation therapy (SBRT) helped the patient into remission for 9 months. Patient 2 is a 32-year-old male with a local PPTID at presentation who went on to receive surgical resection followed by focused adjuvant radiation therapy to the pineal tumor bed. He then presented 6 years after treatment with extensive disseminated recurrence and died due to leptomeningeal disease (LMD) about 4 years after recurrence. The available literature on PPTID is limited and reported cases of LMD with ongoing follow-up in PPTID are scarce. Our report adds to the current known PPTID cases, contributing to the information available regarding prognosis and treatment response. Although an optimal therapeutic strategy for PPTID still cannot be determined, data from the literature suggest that utilizing radiation therapy in patients with low-risk disease and gross total resections as well as the use of upfront CSI have the potential to improve patient progression and survival outcomes.
Collapse
Affiliation(s)
- Cassie Liu
- Eppley Institute for Research in
Cancer and Allied Diseases and the Fred and Pamela Buffett Cancer Center, University of Nebraska Medical
Center, Omaha, NE, USA
| | - Joseph Carmicheal
- Department of Radiation Oncology, University of Nebraska Medical
Center, Omaha, NE, USA
| | - Michael J. Baine
- Department of Radiation Oncology, University of Nebraska Medical
Center, Omaha, NE, USA
| | - Chi Zhang
- Department of Radiation Oncology, University of Nebraska Medical
Center, Omaha, NE, USA
- Chi Zhang, Department of Radiation
Oncology, University of Nebraska Medical Center, Omaha, NE 68198-6861, USA.
| |
Collapse
|
4
|
Webb M, Johnson DR, Mahajan A, Brown P, Neth B, Kizilbash SH, Sener U. Clinical experience and outcomes in patients with pineal parenchymal tumor of intermediate differentiation (PPTID): a single-institution analysis. J Neurooncol 2022; 160:527-534. [DOI: 10.1007/s11060-022-04174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/18/2022] [Indexed: 11/28/2022]
|
5
|
Kerezoudis P, Yolcu YU, Laack N, Ruff MW, Khatua S, Daniels DJ, Burns TC, Kizilbash S. Survival and Associated Predictors for Patients with Pineoblastoma or Pineal Parenchymal Tumor of Intermediate Differentiation Older than 3 years: Insights from the National Cancer Database. Neurooncol Adv 2022; 4:vdac057. [PMID: 35611271 PMCID: PMC9122790 DOI: 10.1093/noajnl/vdac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The management of pineal parenchymal tumors remains controversial. Methods The 2004-2017 National Cancer Database was queried for cases (age >3 years) with histologically confirmed pineal parenchymal tumors of intermediate differentiation (PPTID, n = 90) or pineoblastoma (n = 106). Results Within the PPTID group, median age was 41 years; 49% were males. Five- and 10-year survival were 83% and 78%, respectively. Adjuvant radiation and chemotherapy were administered in 64% and 17% patients, respectively. The effect of radiation with or without chemotherapy (HR 1.15, P = .81, and HR 1.31, P = .72, respectively), and extent of resection (HR = 1.07, P = .93) was not significant. Within the pineoblastoma group, median age was 25 years; 51% were males. Five- and 10-year survival were 66% and 42%, respectively. Adjuvant radiation and chemotherapy were administered in 72% and 51%, respectively. In multivariable analysis, patients with pineoblastoma who received both radiation and chemotherapy (n = 39) had significantly lower hazard of death (HR 0.35, 95% CI 0.14-0.85, P = .02) compared to those who received radiation alone (n = 20) or no adjuvant treatment (n = 19). Finally, females in the pineoblastoma group were found to have a lower hazard of death compared to males (HR 0.24, 95% CI 0.10-0.58, P = .001); this comparison trended toward statistical significance in the PPTID subgroup (HR 0.40, 95% CI 0.14-1.08, P = .07). Conclusions Survival rates were higher in patients with PPTID vs patients with pineoblastoma. Adjuvant chemoradiation was associated with improved survival in pineoblastoma and females had lower hazards of death. Further research should identify specific patient profiles and molecular subgroups more likely to benefit from multimodality therapy.
Collapse
Affiliation(s)
| | - Yagiz Ugur Yolcu
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nadia Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Michael W Ruff
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Soumen Khatua
- Department of Pediatric Oncology, Mayo Clinic, Rochester, MN, USA
| | - David J Daniels
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Terry C Burns
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sani Kizilbash
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
6
|
Chalif EJ, Murray RD, Mozaffari K, Chillakuru YR, Shim T, Monfared A, Sherman JH. Malignant Pineal Parenchymal Tumors in Adults: A National Cancer Database Analysis. Neurosurgery 2022; 90:807-815. [DOI: 10.1227/neu.0000000000001915] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/19/2021] [Indexed: 12/15/2022] Open
|
7
|
Low JT, Kirkpatrick JP, Peters KB. Pineal Parenchymal Tumors of Intermediate Differentiation Treated With Ventricular Radiation and Temozolomide. Adv Radiat Oncol 2021; 7:100814. [PMID: 34746517 PMCID: PMC8554459 DOI: 10.1016/j.adro.2021.100814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/30/2021] [Accepted: 08/27/2021] [Indexed: 01/04/2023] Open
Affiliation(s)
| | - John P. Kirkpatrick
- Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Katherine B. Peters
- Departments of Neurosurgery
- Corresponding author: Katherine B. Peters, MD, PhD
| |
Collapse
|
8
|
Pineal parenchymal tumor of intermediate differentiation: a systematic review and contemporary management of 389 cases reported during the last two decades. Neurosurg Rev 2021; 45:1135-1155. [PMID: 34668090 DOI: 10.1007/s10143-021-01674-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/21/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022]
Abstract
Pineal parenchymal tumor of intermediate differentiation (PPTID) is a WHO grade II and III tumor arising from pineal parenchymal cells. PPTID is a rare tumor accounting for less than 1% of all primary central nervous system neoplasms. Therefore, reports describing the clinical characteristics and biological features of PPTID are lacking. Moreover, the therapeutic strategy remains controversial. The current study aimed to evaluate treatment results and problems of contemporary therapeutic modalities of PPTID based on its features compared with other pineal parenchymal tumors. A comprehensive systematic literature review of 69 articles was performed, including articles on PPTID (389 patients) and similar tumors. Patient demographics, disease presentation, imaging characteristics, biological features, and current therapeutic options and their results were reviewed. We found that histopathological findings based on current WHO classification are well associated with survival; however, identifying and treating aggressive PPTID cases with uncommon features could be problematic. A molecular and genetic approach may help improve diagnostic accuracy. Therapeutic strategy, especially for grade III and aforementioned uncommon and aggressive tumors, remains controversial. A combination therapy involving maximum tumor resection, chemotherapy, and radiotherapy could be the first line of treatment. However, although challenging, a large prospective study would be required to identify ways to improve the clinical results of PPTID treatment.
Collapse
|
9
|
Prognosticating survival of pineal parenchymal tumors of intermediate differentiation (PPTID) by grade. J Neurooncol 2021; 155:165-172. [PMID: 34606044 DOI: 10.1007/s11060-021-03863-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/29/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pineal parenchymal tumors of intermediate differentiation (PPTID) are a rare group of pineal parenchymal tumors classified by histology as either World Health Organization (WHO) Grades 2 or 3. The rarity of these tumors in adults has left a number of clinical management questions open. Correspondingly, the aim of this study was to aggregate a large PPTID cohort with sufficient statistical power from a large national cancer database to analyze prognostic parameters. METHODS All PPTID patients aged over 18 years in the U.S. National Cancer Database (NCDB) between 2005 and 2016 were retrospectively reviewed. Data were summarized and survival was modeled using Kaplan-Meier and Cox regression analyses. RESULTS A total of 103 adult PPTID patients were identified in the NCDB with 63 (61%) WHO Grade 2 and 40 (39%) WHO Grade 3 tumors. Overall, mean age was 53 ± 18 years with even gender distribution. A total of 75 (73%) patients underwent surgical resection for diagnosis, with gross total resection (GTR) was the most common resection outcome in 50/75 (67%). Chemotherapy was utilized in 18 (17%) patients, and radiation therapy in 37 (36%) patients. Overall, 5-year survival rate was estimated to be 54% (95% CI 42-64%), with mean survival was 84 (95% CI 69-99) months. Patients with Grade 2 tumors survived statistically longer than Grade 3 tumor counterparts (P < 0.01). Overall, older age (HR 1.09, P < 0.01) was associated with shorter survival, whereas GTR (HR 0.43, P = 0.02) was associated with longer survival. Both these parameters were significant within Grade 2 and Grade 3 subgroup analyses as well. CONCLUSIONS PPTID are rare tumors with expected mean survival more than 5 years, although Grade 2 tumors are expected to survive longer than Grade 3 tumors. Age and gross total resection are significant independent predictors of survival in PPTID overall, as well as within Grade 2 and Grade 3 subgroups separately. The prognostic role and benefit of adjuvant therapy is yet to be elucidated, mandating more molecular and biologic research be done to further optimize clinical management in the future.
Collapse
|
10
|
Kunigelis KE, Kleinschmidt-DeMasters BK, Youssef AS, Lillehei KO, Ormond DR. Clinical Features of Pineal Parenchymal Tumors of Intermediate Differentiation (PPTID): A Single-Institution Series. World Neurosurg 2021; 155:e229-e235. [PMID: 34418607 DOI: 10.1016/j.wneu.2021.08.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Pineal parenchymal tumors of intermediate differentiation (PPTID) are rare tumors of the pineal gland. Their treatment is often heterogeneous due to the lack of literature to compile standardized treatments. Although no single institution has large numbers of cases, our experience has been that the clinical course is more varied and complicated than reported. METHODS We reviewed the clinical data for all patients with pathology found to be consistent with PPTID at our institution between the years 2006 and 2019. RESULTS Nine patients were identified. At initial diagnosis, all were treated with surgery and 4 of 9 patients underwent gross total resection. Adjuvant radiation therapy to the resection bed was administered in 6 of 9 patients. Mean follow-up time was 95.3 months. Mean progression-free survival was 50.5 months, with a tendency to be longer for male sex and after gross total resection. Seven patients developed a recurrence. Five of 6 known locations of first recurrences had either distant metastases or dissemination of disease. First recurrences were treated with radiation alone in 5 patients, craniospinal radiation with multiagent chemotherapy in 1 patient, and surgery with radiation therapy in 1. At last follow-up, 2 patients had died. CONCLUSIONS Herein, we report clinical patterns of disease progression and treatment patterns of PPTID. Many patients progressed during the follow-up period. Disseminated disease was the most common presentation at recurrence. Ultimately, given the risk of recurrence and dissemination at recurrence, more aggressive treatment strategies should be considered. Specifically, our series suggests a benefit of adjuvant radiation at initial diagnosis for grade II patients.
Collapse
Affiliation(s)
- Katherine E Kunigelis
- Department of Neurosurgery, The University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - A Samy Youssef
- Department of Neurosurgery, The University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kevin O Lillehei
- Department of Neurosurgery, The University of Colorado School of Medicine, Aurora, Colorado, USA
| | - D Ryan Ormond
- Department of Neurosurgery, The University of Colorado School of Medicine, Aurora, Colorado, USA.
| |
Collapse
|
11
|
Nam JY, Gilbert A, Cachia D, Mandel J, Fuller GN, Penas-Prado M, de Groot J, Kamiya-Matsuoka C. Pineal parenchymal tumor of intermediate differentiation: a single-institution experience. Neurooncol Pract 2020; 7:613-619. [PMID: 33312675 DOI: 10.1093/nop/npaa024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Pineal parenchymal tumors are exceedingly rare brain tumors responsible for less than 1% of all adult primary intracranial malignancies in the United States. In this study, we describe the clinicopathologic features, management, and outcomes of patients with pineal parenchymal tumor of intermediate differentiation (PPTID). Methods We describe a single-center, multidisciplinary team experience in managing PPTID patients over a 15-year period (January 2000 to January 2015) at The University of Texas MD Anderson Cancer Center (MDACC). Pathology was reviewed by the pathology collaborators (A.G. and G.N.F.) and retrospective chart review was performed for treatment and clinical outcomes. Results We identified 17 patients (9 male) with diagnosis of PPTID. Median age at diagnosis of PPTID was 37 years (range, 15-57 years). Follow-up ranged from 0.1 to 162.8 months with 6 reported deaths. Most patients presented with headaches and diplopia. Three patients had neuroaxial dissemination at initial diagnosis, and recurrence of tumor was common (7/16) despite treatment. Conclusions No clear prognostic factors were identified in this series. Extension of resection showed a trend toward improved survival. PPTID with neuroaxial dissemination benefits from aggressive initial treatment including craniospinal irradiation and adjuvant chemotherapy, whereas localized disease may be treated traditionally with maximum debulking followed by adjuvant radiotherapy alone. Long-term monitoring is recommended for neurotoxicity and/or late recurrence.
Collapse
Affiliation(s)
- Joo Yeon Nam
- Department of Neuro-Oncology, Rush University Medical Center, Chicago, Illinois
| | - Andrea Gilbert
- Department of Pathology, Houston Methodist Hospital, Houston, Texas
| | - David Cachia
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, Houston, Texas
| | - Gregory N Fuller
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marta Penas-Prado
- Department of Neuro-Oncology, National Cancer Institute/National Institutes of Health, Bethesda, Maryland
| | - John de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
12
|
CD24 and PRAME Are Novel Grading and Prognostic Indicators for Pineal Parenchymal Tumors of Intermediate Differentiation. Am J Surg Pathol 2019; 44:11-20. [DOI: 10.1097/pas.0000000000001350] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Tom M, Murphy ES. Resection Bed Only. Int J Radiat Oncol Biol Phys 2018; 102:487-488. [DOI: 10.1016/j.ijrobp.2018.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/11/2018] [Indexed: 10/28/2022]
|
14
|
Chan M. Not to Treat. Int J Radiat Oncol Biol Phys 2018; 102:487. [PMID: 30238898 DOI: 10.1016/j.ijrobp.2018.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/19/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Michael Chan
- Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
15
|
Bando T, Ueno Y, Shinoda N, Imai Y, Ichikawa K, Kuramoto Y, Kuroyama T, Shimo D, Mikami K, Hori S, Matsumoto M, Hirai O. Therapeutic strategy for pineal parenchymal tumor of intermediate differentiation (PPTID): case report of PPTID with malignant transformation to pineocytoma with leptomeningeal dissemination 6 years after surgery. J Neurosurg 2018; 130:2009-2015. [PMID: 30028263 DOI: 10.3171/2018.2.jns171876] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 02/08/2018] [Indexed: 11/06/2022]
Abstract
Pineal parenchymal tumor of intermediate differentiation (PPTID) is rare. The WHO first classified PPTID in 2000 as a pineal parenchymal tumor (PPT) with an intermediate prognosis between pineocytoma (PC) and pineoblastoma (PB). It is considered an intermediate-grade tumor and divided into WHO grade II or III.The number of available reports about PPTID is presently limited, and the appropriate management for this tumor has not yet been determined.The authors report a rare case of PC in a 63-year-old woman who presented with lower-extremity weakness and gait disturbance. A pineal mass lesion was detected on MRI. A diagnosis of PC was established after microsurgical gross-total tumor resection, and the patient received no adjuvant therapy after surgery. Two years after surgery, a partial recurrence was recognized and Gamma Knife radiosurgery was performed. Fours years later, the patient developed diffuse leptomeningeal dissemination. She was successfully treated with craniospinal irradiation. Leptomeningeal dissemination may develop 6 years after the initial diagnosis of PC. A histopathological study of the recurrent tumor revealed a malignant change from PC to PPTID.The present case shows the importance of long-term follow-up of patients with PPTs following resection and the efficacy of craniospinal irradiation in the treatment of leptomeningeal dissemination.
Collapse
Affiliation(s)
- Toshiaki Bando
- 1Department of Neurosurgery and Stroke Center, Shinko Hospital
| | - Yasushi Ueno
- 1Department of Neurosurgery and Stroke Center, Shinko Hospital
| | | | - Yukihiro Imai
- 2Department of Pathology, Kobe City Medical Center General Hospital; and
| | | | - Yoji Kuramoto
- 1Department of Neurosurgery and Stroke Center, Shinko Hospital
| | | | - Daisuke Shimo
- 1Department of Neurosurgery and Stroke Center, Shinko Hospital
| | - Kazuyuki Mikami
- 1Department of Neurosurgery and Stroke Center, Shinko Hospital
| | - Shinya Hori
- 1Department of Neurosurgery and Stroke Center, Shinko Hospital
| | | | - Osamu Hirai
- 1Department of Neurosurgery and Stroke Center, Shinko Hospital
| |
Collapse
|