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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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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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3
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Biswas R, Kumari K, Haresh KP, Gupta S, Halder A, Rath GK. Papillary Tumor of the Pineal Region in an Adolescent. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_251_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rituparna Biswas
- Department of Radiation Oncology, Dr. B. R. A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Kalpana Kumari
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - K P Haresh
- Department of Radiation Oncology, Dr. B. R. A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Subhash Gupta
- Department of Radiation Oncology, Dr. B. R. A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Anirban Halder
- Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi, India
| | - G K Rath
- Department of Radiation Oncology, Dr. B. R. A. IRCH, All India Institute of Medical Sciences, New Delhi, India
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4
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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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5
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Kuo CH, Yen YS, Tu TH, Wu JC, Huang WC, Cheng H. Primary Choroid Plexus Papilloma over Sellar Region Mimicking with Craniopharyngioma: A Case Report and Literature Review. Cureus 2018; 10:e2849. [PMID: 30140600 PMCID: PMC6103389 DOI: 10.7759/cureus.2849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Choroid plexus papillomas (CPPs) are slow-growing and benign tumors, representing less than 1% of all intracranial neoplasms. They are predominantly located in the lateral ventricles in children, and in the fourth ventricle in adults. Primary CPP over sellar regions is extremely rare. There was previously only one case reported in men. We report the case of a 43-year-old male who initially presented with bilateral temporal hemiapnosia. A brain magnetic resonance imaging (MRI) revealed heterogenous enhanced mass lesion with cyst component compressing upward onto the optic chiasm. A craniopharyngioma was initially suspected. Further endoscopic trans-sphenoidal surgery (ETS) was performed for total tumor resection. After surgery, the patient had visual field improved without tumor recurrence on post-operative MRI in clinical follow-up. Histopathological examination of the lesion confirmed the diagnosis of CPP, with fibrovascular cores covered by a single layer of cuboidal to columnar epithelial cells. CPP is a rare tumor without specific clinical patterns or imaging findings. Therefore, pre-operative differential diagnosis is difficult for this kind of tumor with complete separation from ventricular system. An ETS for total tumor resection provided effective treatment.
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Affiliation(s)
- Chao-Hung Kuo
- Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN
| | - Yu-Shu Yen
- Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN
| | - Tsung-Hsi Tu
- Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN
| | - Jau-Ching Wu
- Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN
| | | | - Henrich Cheng
- Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN
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6
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Aggarwal SK, Agarwal P, Sahu RN. Papillary tumor of pineal region with an unusual clinical presentation: Case report and review of the literature. Asian J Neurosurg 2016; 11:78-9. [PMID: 26889301 PMCID: PMC4732264 DOI: 10.4103/1793-5482.172592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Papillary tumor of the pineal region (PTPR) is a newly described entity, which has been recently included in the World Health Organization classification of central nervous system tumors. We report an unusual presentation of PTPR in a 17-year-old girl, which was extending into the third ventricle, along with a detailed description of morphological and immunohistochemical characteristics of PTPRs. The diagnosis of PTPR was established on immunohistopathological examination.
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Affiliation(s)
| | - Preeti Agarwal
- Department of Pathology, SGPGIMS, Lucknow, Uttar Pradesh, India
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7
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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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8
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Papillary Tumor of the Pineal Region: MR Signal Intensity Correlated to Histopathology. Case Rep Neurol Med 2015; 2015:315095. [PMID: 25688307 PMCID: PMC4320939 DOI: 10.1155/2015/315095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/06/2015] [Indexed: 11/17/2022] Open
Abstract
Tumors of the pineal region are rare and can be challenging to differentiate by imaging. Papillary tumor of the pineal region (PTPR) was recently recognized as a neoplasm in the World Health Organization (WHO) 2007 classification, arising from specialized ependymocytes in the subcommissural organ, which is located in the pineal region. It is a rare histological type of pineal tumor with only a few cases reported. Here, we describe a case of histologically confirmed PTPR in a 17-year-old man who presented with a headache. A literature review was performed to clarify the clinical, radiological, and pathological features of PTPR. Pineal neoplasms do not have pathognomonic imaging findings; however, we discuss T1 hyperintensity, which is a key for imaging diagnosis according to recent reports. In particular, if the hyperintensity in T1 is not due to fat, calcification, melanin, or hemorrhage in a mass of the posterior commissure or pineal region, the diagnosis of a PTPR may be suggested, as observed in this case.
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9
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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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10
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Cohen AL, Salzman K, Palmer C, Jensen R, Colman H. Bevacizumab is Effective for Recurrent Papillary Tumor of the Pineal Region: First Report. Case Rep Oncol 2013; 6:434-40. [PMID: 24019784 PMCID: PMC3764969 DOI: 10.1159/000354753] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Papillary tumor of the pineal region (PTPR) is a rare brain tumor that probably arises from ependymal cells. There are no known systemic treatments for PTPR once it is refractory to surgery and radiation. We present the first case of a durable radiographic and clinical response of a PTPR to bevacizumab, an antibody against vascular endothelial growth factor, despite multiple prior treatments. Bevacizumab may be an effective treatment for PTPR.
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Affiliation(s)
- Adam L Cohen
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
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11
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Magalhães J, Rostad S, Foltz G, Pytel P, Rodriguez FJ. Cellular pleomorphism in papillary tumors of the pineal region. Brain Tumor Pathol 2013; 30:93-8. [PMID: 22622671 PMCID: PMC4696054 DOI: 10.1007/s10014-012-0103-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 05/07/2012] [Indexed: 11/30/2022]
Abstract
Papillary tumor of the pineal region (PTPR) is a recently recognized entity. We present the pathologic findings of two cases of PTPR as examples, and discuss the presence of cellular pleomorphism in these tumors. Patient 1 is a 48-year-old man with a pineal region mass. The tumor had unique biphasic patterns, papillary/pseudopapillary areas, and increased mitotic activity. Juxtaposed areas had marked pleomorphism, including nuclear enlargement, smudgy chromatin, nuclear pseudoinclusions, and cytoplasmic vacuolation. Mitoses were absent in these areas. Immunohistochemical staining revealed strong S100 expression. CAM 5.2 and CK18 were strongly positive in a patchy fashion. MIB1 labeling indices were high in classic PTPR regions but very low in pleomorphic areas. Patient 2 was a 35-year-old male with a pineal region tumor characterized by papillary architecture and overall cellular monotony, rare mitoses, and pleomorphism as a more isolated finding, with associated nuclear enlargement and crowding. S100 and CAM 5.2 labeling were present, and MIB1 labeling index was very low throughout the tumor. We discuss the pathologic and phenotypic features of PTPR. Variable pleomorphism may be present, reflected in size variation and nuclear hyperchromasia, but was not accompanied by increased proliferative activity in these cases, suggesting a degenerative phenomenon.
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Affiliation(s)
- Juliana Magalhães
- Division of Neuropathology, Department of Pathology, Johns Hopkins University, Sheikh Zayed Tower, Room M2101, 1800 Orleans Street, Baltimore, MD 21231, USA
| | - Steven Rostad
- Department of Pathology, Swedish Medical Center, Seattle, WA, USA
| | - Greg Foltz
- Department of Neurosurgery, Swedish Medical Center, Seattle, WA, USA
| | - Peter Pytel
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Fausto J. Rodriguez
- Division of Neuropathology, Department of Pathology, Johns Hopkins University, Sheikh Zayed Tower, Room M2101, 1800 Orleans Street, Baltimore, MD 21231, USA
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12
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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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13
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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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14
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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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15
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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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16
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Bian LG, Sun QF, Wu HC, Jiang H, Sun YH, Shen JK. Primary choroid plexus papilloma in the pituitary fossa: case report and literature review. Acta Neurochir (Wien) 2011; 153:851-7. [PMID: 21140177 DOI: 10.1007/s00701-010-0884-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Accepted: 11/12/2010] [Indexed: 11/30/2022]
Abstract
Choroid plexus papillomas are rare tumors of the central nervous system and are usually confined to the ventricular system. We illustrated a primary choroid plexus papilloma in the pituitary fossa. A 31-year-old female presented with amenorrhea and intermittent galactorrhoea, with no visual complaints in the last 2 years. Endocrine testing showed no hormone excess or deficiency of the pituitary and target glands, except for a higher prolactin level (56 ng/ml). A sharply circumscribed regular mass in the sellar region occupying the entire sella turcica and extending into the suprasellar cistern was demonstrated on MR imaging with gadolinium diethylenetriamine pentaacetic acid. The patient underwent an endonasal trans-sphenoidal approach. Complete microsurgical excision and complete preservation of the normal pituitary gland was achieved, with normal prolactin level. The histopathology showed that the lesion was a choroid plexus papilloma. Theories of the origin, the differential diagnosis, and treatment of the rare tumor are discussed.
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Affiliation(s)
- Liu-Guan Bian
- Department of Neurosurgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, People's Republic of China.
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17
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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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18
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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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19
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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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Inoue T, Kumabe T, Kanamori M, Sonoda Y, Watanabe M, Tominaga T. Papillary tumor of the pineal region: a case report. Brain Tumor Pathol 2008; 25:85-90. [DOI: 10.1007/s10014-008-0231-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 03/21/2008] [Indexed: 10/21/2022]
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Fèvre-Montange M, Grand S, Champier J, Hoffmann D, Pasquier B, Jouvet A. Bcl-2 expression in a papillary tumor of the pineal region. Neuropathology 2008; 28:660-3. [PMID: 18410278 DOI: 10.1111/j.1440-1789.2008.00906.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neuroepithelial papillary tumor of the pineal region (PTPR) has been described by several groups and recognized by the 2007 World Health Organization Classification of Tumors of the Central Nervous System. The proto-oncogen Blc-2 can function as an apoptosis suppressor and can promote neoplastic transformation. It may also be involved in neuroendocrine differentiation in some tumors. As PTPRs express neuroendocrine markers, we investigated the expression of Bcl-2 in tumoral cells of a new case of PTPR in a 42-year-old woman. Bcl-2 immunostaining was detected in the cytoplasm of the tumoral cells; staining intensity was heterogeneous from cell to cell and more intense in papillary areas. This intense expression of Bcl-2 in one case of PTPR with a high proliferation index (8%) might be related to the malignancy of this neoplasm. It will be interesting to investigate the prognosis impact of Bcl-2 expression in a large series of PTPRs.
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