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Fakhry M, Elayadi M, Elzayat MG, Samir O, Maher E, Taha H, El-Beltagy M, Refaat A, Zamzam M, Abdelbaki MS, Sayed AA, Kieran M, Elhaddad A. Plasma miRNA expression profile in pediatric pineal pure germinomas. Front Oncol 2024; 14:1219796. [PMID: 38665953 PMCID: PMC11043570 DOI: 10.3389/fonc.2024.1219796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background Pure germinomas account for 40% of pineal tumors and are characterized by the lack of appreciable tumor markers, thus requiring a tumor biopsy for diagnosis. MicroRNAs (miRNA) have emerged as potential non-invasive biomarkers for germ cell tumors and may facilitate the non-invasive diagnosis of pure pineal germinomas. Material and methods A retrospective chart review was performed on all patients treated at the Children's Cancer Hospital Egypt diagnosed with a pineal region tumor between June 2013 and March 2021 for whom a research blood sample was available. Plasma samples were profiled for miRNA expression, and DESeq2 was used to compare between pure germinoma and other tumor types. Differentially expressed miRNAs were identified. The area under the curve of the receive;r operating characteristic curve was constructed to evaluate diagnostic performance. Results Samples from 39 pediatric patients were available consisting of 12 pure germinomas and 27 pineal region tumors of other pathologies, including pineal origin tumors [n = 17; pineoblastoma (n = 13) and pineal parenchymal tumors of intermediate differentiation (n = 4)] and others [n = 10; low-grade glioma (n = 6) and atypical teratoid rhabdoid tumor (n = 4)]. Using an adjusted p-value <0.05, three miRNAs showed differential expression (miR-143-3p, miR-320c, miR-320d; adjusted p = 0.0058, p = 0.0478, and p = 0.0366, respectively) and good discriminatory power between the two groups (AUC 90.7%, p < 0.001) with a sensitivity of 25% and a specificity of 100%. Conclusion Our results suggest that a three-plasma miRNA signature has the potential to non-invasively identify pineal body pure germinomas which may allow selected patients to avoid the potential surgical complications.
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Affiliation(s)
- Mona Fakhry
- Department of Pediatric Oncology, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Moatasem Elayadi
- Department of Pediatric Oncology, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
- Department of Pediatric Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Mariam G. Elzayat
- Genomics and Epigenomics Program, Research Department, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Omar Samir
- Genomics and Epigenomics Program, Research Department, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Eslam Maher
- Clinical Research Department, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Hala Taha
- Department of Pathology, National Cancer Institute (NCI), Cairo University and Children Cancer Hospital (CCHE-57357), Cairo, Egypt
| | - Mohamed El-Beltagy
- Department of Neurosurgery, Children’s Cancer Hospital Egypt (CCHE-57357) and Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amal Refaat
- Radio-Diagnosis Department, National Cancer Institute (NCI), Cairo University and Children Cancer Hospital (CCHE-57357), Cairo, Egypt
| | - Manal Zamzam
- Department of Pediatric Oncology, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
- Department of Pediatric Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Mohamed S. Abdelbaki
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Ahmed A. Sayed
- Genomics and Epigenomics Program, Research Department, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
- Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Mark Kieran
- Department of Pediatric Oncology, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Alaa Elhaddad
- Department of Pediatric Oncology, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
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Bora S, Santhoor HA, Kumar A, Das S, Sharma MC, Mishra S, Singh PK, Laythalling RK, Kale SS. Papillary Tumors of Pineal Region: A Single-Center Experience in Management of 11 Cases. World Neurosurg 2024; 184:e486-e493. [PMID: 38307196 DOI: 10.1016/j.wneu.2024.01.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Papillary tumors of pineal region (PTPR) comprise a very rare subset of pineal region tumors that have been recently described. Literature on the management and outcome of PTPR is scarce owing to the rarity of these tumors. To address this lacuna, we analyzed our experience in management of PTPR. METHODS We retrospectively analyzed the outcome of 11 patients with histopathologically proven PTPR who underwent surgical excision at our center. RESULTS Mean patient age was 33.3 years (range, 12-45 years), and male-to-female ratio was 1.75:1. Headache was the most common presentation followed by visual disturbances, altered sensorium, Perinaud syndrome, and seizures. Cerebrospinal fluid diversion was required in 6 patients. Krause approach was the most common approach used for tumor excision (9/11 cases). There was no perioperative mortality. Two patients were lost to follow-up. In the remaining 9 patients, the average follow-up period was 45 months (range, 12-79 months). On first postoperative magnetic resonance imaging, 8 patients showed no evidence of residual tumor (gross total resection), while 1 patient had small residual tumor (near-total resection) that remained stable during follow-up. Four patients underwent adjuvant chemoradiotherapy. None of the patients developed recurrence during follow-up. CONCLUSIONS PTPR are a rare subgroup of pineal region tumors with distinct cells of origin but presentation similar to other pineal region tumors. Surgical resection constitutes the mainstay of management, and the extent of resection appears to be the most important determinant of prognosis. The role of adjuvant therapy still needs to be determined.
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Affiliation(s)
- Santanu Bora
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Hemanth A Santhoor
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amandeep Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Sumanta Das
- Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India
| | - Meher C Sharma
- Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj K Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Guarnizo A, Maldonado F, Baroni L, Fernández-Ponce N, Rugilo C. An atypical location of pineoblastoma RB1 subgroup without pineal or retinal tumor. Childs Nerv Syst 2024; 40:961-964. [PMID: 37917406 DOI: 10.1007/s00381-023-06201-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To describe the clinical and imaging features of a sellar-suprasellar pineoblastoma RB1 subgroup without pineal or retinal involvement. CASE REPORT An 11-month-old girl presented to the emergency department with fever, rhinorrhea, vomiting, altered level of consciousness, and one seizure. Head CT and brain MRI demonstrated a large lobulated mass with calcifications and heterogeneous enhancement in the suprasellar region causing mass effect to the ventricular system and hydrocephalus. Histology revealed a CNS embryonal tumor not otherwise specified (NOS) with small round nuclei with mitotic activity and necrosis. DNA methylation analysis classified the tumor in the pineoblastoma RB1 subgroup. CONCLUSION Pineoblastoma RB1 subgroup should be considered in the differential diagnosis of large sellar-suprasellar masses with calcifications and heterogeneous enhancement in children younger than 18 months even in cases of absent pineal or retinal involvement. Molecular analysis with DNA methylation profiling is critical for diagnosis and management.
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Affiliation(s)
- Angela Guarnizo
- Diagnostic Neuroradiology Unit, Department of Radiology, Fundación Santa Fe de Bogotá, Carrera 7 #117-15 (110111), Bogotá, Colombia.
| | - Francisco Maldonado
- Diagnostic Neuroradiology Unit, Department of Radiology, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Lorena Baroni
- Department of Neuro-oncology, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Nicolás Fernández-Ponce
- Department of Neuro-oncology, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Carlos Rugilo
- Diagnostic Neuroradiology Unit, Department of Radiology, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
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Niranjan UR, Kumaran SP, Sriramanakoppa NN, Viswamitra S. Restricted diffusion in benign intracranial neoplasms: a narrative review. Pol J Radiol 2023; 88:e494-e505. [PMID: 38020500 PMCID: PMC10660144 DOI: 10.5114/pjr.2023.132536] [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] [Received: 08/22/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023] Open
Abstract
Diffusion-weighted imaging (DWI) is a valuable diagnostic tool, which provides functional information by exploring the free diffusivity of water molecules into intra- and inter-cellular spaces that in tumours mainly depend on cellularity. It provides information regarding the tumour grade and helps with the diagnosis. Often high-grade tumours show restricted diffusion due to a high degree of cellularity, increased nuclear-to-cytoplasmic ratio, and reduced extracellular space. Benign central nervous system (CNS) tumours rarely show restricted diffusion on magnetic resonance imaging (MRI), and most of them have a characteristic imaging appearance. When benign CNS neoplasms reveal restricted diffusion on MRI, the radiologist is compelled to suggest a malignant neoplasm, making their diagnosis challenging. Knowledge of these exceptions helps to avoid possible errors in diagnosis. We present this integrated review with clinical, radiology-pathological correlation.
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Jones VM, Kanter JH, Russo GA, Simmons NE, Tafe LJ, Zanazzi GJ. A Pineal Parenchymal Tumor of Intermediate Differentiation in an Octogenarian Contains a Rare KBTBD4 Insertion. Int J Surg Pathol 2023:10668969231201411. [PMID: 37855103 DOI: 10.1177/10668969231201411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Pineal parenchymal tumors are rare central nervous system tumors that pose diagnostic challenges for surgical pathologists. Due to their paucity, their clinicopathologic features are still being defined. We report an 86-year-old woman with a remote history of breast lobular carcinoma who presented with a 2-month neurologic history that included gait instability, blurry vision, and headaches. Magnetic resonance imaging revealed a lobular, heterogeneously enhancing pineal region mass compressing the aqueduct of Sylvius. A biopsy performed concomitant with endoscopic third ventriculostomy consisted of small sheets of cells with eosinophilic to clear cytoplasm, multipolar processes, and ovoid nuclei with stippled chromatin. Whole exome sequencing revealed a small in-frame insertion (duplication) in exon 4 of KBTBD4 (c.931_939dup, p.P311_R313dup/ p.R313_M314insPRR), which has very recently been reported in 2 pineal parenchymal tumors of intermediate differentiation (PPTID). Additionally, variants of uncertain significance in CEBPA (c.863G > C, p.R288P) and MYC (c.655T > C, p.S219P) were identified. Although PPTID is considered a disease of young adulthood, review of 2 institutional cohorts of patients with pineal region tumors revealed that 25% of individuals with PPTID were over 65 years of age. In conclusion, PPTID should be considered in the differential diagnosis of pineal region tumors in older adults.
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Affiliation(s)
- Victoria M Jones
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - John H Kanter
- Department of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Gregory A Russo
- Department of Radiation Oncology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Nathan E Simmons
- Department of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Laura J Tafe
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - George J Zanazzi
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Panyaping T, Tritanon O, Wisetsathon P, Chansakul T, Pongpitcha P. Accuracy of apparent diffusion coefficient values for distinguishing between pineal germ cell tumour and pineoblastoma. Clin Radiol 2023:S0009-9260(23)00101-0. [PMID: 37037704 DOI: 10.1016/j.crad.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/09/2022] [Accepted: 03/13/2023] [Indexed: 04/12/2023]
Abstract
AIM To differentiate between pineal germ cell tumour and pineoblastoma using apparent diffusion coefficient (ADC) values due to their overlapping imaging findings on magnetic resonance imaging (MRI). MATERIALS AND METHODS This retrospective study was conducted on 33 patients with pineal germ cell tumours and eight patients with pineoblastoma who underwent pretreatment MRI. Twenty-seven patients (21 with pineal germ cell tumour and six with pineoblastoma) were included for ADC measurement. The minimum and mean ADC values of the tumours were measured, with normalized tumour to control ADC ratios generated. The MRI characteristics of the tumours were evaluated. RESULTS The mean and minimum ADC values, normalized mean and minimum ADC ratios of pineal germ cell tumours were significantly higher than those of pineoblastomas (all p<0.005). A cut-off value of 0.92 for the normalized mean ADC ratio was used to distinguish between pineal germ cell tumour and pineoblastoma and achieved an area under the curve of 0.95, sensitivity of 90.5%, specificity of 83.3%, and accuracy of 92.6%. An equal degree of contrast enhancement to the adjacent venous sinus was the only MRI characteristic that suggested the diagnosis of pineal germ cell tumour. CONCLUSION The ADC values could help differentiate between pineal germ cell tumour and pineoblastoma, specifically when conventional MRI findings are indeterminate.
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Affiliation(s)
- T Panyaping
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
| | - O Tritanon
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand.
| | - P Wisetsathon
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
| | - T Chansakul
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
| | - P Pongpitcha
- Department of Paediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
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7
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Phuttharak W, Wannasarnmetha M, Lueangingkasut P, Waraasawapati S, Mukherji SK. Differentiation between germinoma and other pineal region tumors using diffusion-and susceptibility-weighted MRI. Eur J Radiol 2023; 159:110663. [PMID: 36584565 DOI: 10.1016/j.ejrad.2022.110663] [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: 07/04/2022] [Revised: 11/26/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the effectiveness of diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) for differentiation between germinoma and other pineal region tumors. METHOD This retrospective study consisted of 72 patients with pathologically proven pineal region tumors between January 2010 and August 2020. Tumors were classified as germinomas (40), non-germinomatous germ cell tumors (11) (NGGCT), pineal parenchymal tumors (10) (PPT), and other types of tumors (11). Visual scale score, ADC values and SWI intratumoral susceptibility signal (ITSS) score were analyzed and compared to histopathology data. RESULTS The mean apparent diffusion coefficient (ADCmean) and minimum apparent diffusion coefficient (ADCmin) ratio of germinoma were significantly lower than NGGCT. ADCmean or ADCmin cut-off ratio of ≤ 1.48 or ≤ 1.32 allowed for discrimination between germinoma and NGGCT with sensitivity and specificity of 100 % and 63.6 %. An ADCmin cut-off ratio of ≥ 0.93 allowed for discrimination between germinoma and PPT with sensitivity and specificity of 60 % and 80.0 %. ADCmin cut-off ratio of ≤ 1.15 allowed for discrimination of germinoma from other types of tumors with sensitivity and specificity of 87.5 % and 54.5 %. CONCLUSIONS ADC ratio can differentiate germinoma from other types of pineal region tumors. Our initial results suggest that ITSS score was not significantly correlated with specific histology subtype.
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Affiliation(s)
- Warinthorn Phuttharak
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Mix Wannasarnmetha
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
| | - Peerawit Lueangingkasut
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sakda Waraasawapati
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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Upadhyayula PS, Neira JA, Miller ML, Bruce JN. Benign and Malignant Tumors of the Pineal Region. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:153-173. [PMID: 37452938 DOI: 10.1007/978-3-031-23705-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Pineal region tumors fall into five broad categories: benign pineal region tumors, glial tumors, papillary tumors, pineal parenchymal tumors, and germ cell tumors. Genetic and transcriptional studies have identified key chromosomal alterations in germinomas (RUNDC3A, ASAH1, LPL) and in pineocytomas/pineoblastomas (DROSHA/DICER1, RB1). Pineal region tumors generally present with symptoms of hydrocephalus including nausea, vomiting, papilledema, and the classical Parinaud's triad of upgaze paralysis, convergence-retraction nystagmus, and light-near pupillary dissociation. Workup requires neuroimaging and tissue diagnosis via biopsy. In germinoma cases, diagnosis may be made based on serum or CSF studies for alpha-fetoprotein or beta-HCG making the preferred treatment radiosurgery, thereby preventing the need for unnecessary surgeries. Treatment generally involves three steps: CSF diversion in cases of hydrocephalus, biopsy through endoscopic or stereotactic methods, and open surgical resection. Multiple surgical approaches are possible for approach to the pineal region. The original approach to the pineal region was the interhemispheric transcallosal first described by Dandy. The most common approach is the supracerebellar infratentorial approach as it utilizes a natural anatomic corridor for access to the pineal region. The paramedian or lateral supracerebellar infratentorial approach is another improvement that uses a similar anatomic corridor but allows for preservation of midline bridging veins; this minimizes the chance for brainstem or cerebellar venous infarction. Determination of the optimal approach relies on tumor characteristics, namely location of deep venous structures to the tumor along with the lateral eccentricity of the tumor. The immediate post-operative period is important as hemorrhage or swelling can cause obstructive hydrocephalus and lead to rapid deterioration. Adjuvant therapy, whether chemotherapy or radiation, is based on tumor pathology. Improvements within pineal surgery will require improved technology for access to the pineal region along with targeted therapies that can effectively treat and prevent recurrence of malignant pineal region tumors.
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Affiliation(s)
| | - Justin A Neira
- Department of Neurological Surgery, Columbia University, New York, USA
| | - Michael L Miller
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Jeffrey N Bruce
- Department of Neurological Surgery, Columbia University, New York, USA.
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Ye N, Yang Q, Liu P, Chen Z, Li X. A comprehensive machine-learning model applied to MRI to classify germinomas of the pineal region. Comput Biol Med 2023; 152:106366. [PMID: 36470145 DOI: 10.1016/j.compbiomed.2022.106366] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/20/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pineal region tumors (PRTs) are highly histologically heterogeneous. Germinoma is the most common PRT and is treatable with radiotherapy and chemotherapy. A non-invasive system that helps identify germinoma in the pineal region could reduce lab exams and traumatic therapies. METHODS In this retrospective study, 122 patients with histologically confirmed PRTs and pre-operative multi-modal MR images were included. Radiomics features were extracted from different ROIs and image sequences separately. A computational framework that combines a few classification and feature selection algorithms were used to predict histology with radiomics features and demographics. We systemically benchmarked performance of models with feature matrices from all possible combinations of ROIs and image sequences. The Area under the ROC Curve (AUC) was then used to evaluate model performance. RESULTS Models with demographics and radiomics features outperform radiomics-only or demographics-only models. The best demographical-radiomics model reached the highest AUC of 0.88 (CI95%: 0.81-0.96). Through the comprehensive evaluation of possible sequence combinations in the differential diagnosis of pineal tumor, T1 and T2 emerged as the most informative sequences for the task. There is imbalanced usage of feature classes as we analyze their proportion in all models. CONCLUSIONS The demographical-radiomics model can accurately and efficiently identify germinomas in the pineal region. The preference for MRI sequences, radiomics feature classes, features selection and classification algorithms provide a valuable reference for future attempts at developing classifiers on medical images.
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Affiliation(s)
- Ningrong Ye
- Department of Neurosurgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, Hunan, 410008, PR China; Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, Hunan, 410008, PR China
| | - Qi Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, Hunan, 410008, PR China; Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, Hunan, 410008, PR China
| | - Peikun Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, Hunan, 410008, PR China; Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, Hunan, 410008, PR China
| | - Ziyan Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, Hunan, 410008, PR China; Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, Hunan, 410008, PR China
| | - Xuejun Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, Hunan, 410008, PR China; Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, Hunan, 410008, PR China.
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Muacevic A, Adler JR. Pineal Gland Tumour With Drop Metastases: A Case Report. Cureus 2022; 14:e29855. [PMID: 36204259 PMCID: PMC9528170 DOI: 10.7759/cureus.29855] [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] [Accepted: 10/03/2022] [Indexed: 12/02/2022] Open
Abstract
Pineal gland tumours are reported rarely in Malayasia and early diagnosis and intervention promise a better prognosis for patients. We report a rare case of pineal gland tumour with drop metastases in the fourth ventricle in a 20-year-old young male with Parinaud syndrome. The patient, who had no underlying medical illnesses, presented with neurological symptoms and limb weakness associated with tremors and blurring of vision which worsened over a span of four months. The patient was having difficulty in ambulating with reduced power over the lower limbs with tremors as well as Parinaud syndrome indicated through the limitation of upward gaze, light-near dissociation of the pupils and convergence nystagmus. An MRI showed the presence of a pineal gland tumour with drop metastases in the fourth ventricle with calcification. The patient underwent an endoscopic third ventriculostomy and tumour biopsy. The biopsy indicated a pineal gland tumour with a germinoma subset and the patient was subjected to radiotherapy. Latency of diagnosis is an important prognostic factor as it reduces the survival rate for these patients hence the following discussion on the pineal gland tumour and its diagnostic dilemma.
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11
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Kabashi S, Ahmetgjekaj I, Harizi E, Hyseni F, Kola E, Vokshi V, Hyseni G, Kola I, Haroon H, Rahman M, Shemsi K, Decka A, Capi L, Goçaj K, Musa J. Mixed germ cell tumor of the pineal gland in a pediatric patient. Radiol Case Rep 2022; 17:2940-2945. [PMID: 35755097 PMCID: PMC9218299 DOI: 10.1016/j.radcr.2022.05.024] [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] [Received: 04/20/2022] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 12/03/2022] Open
Abstract
Tumors of the pineal region are a rare clinical entity, comprising approximately 3%-8% of pediatric tumors. Based on their histopathological features, they are typically classified as pineal parenchymal tumors and germ cell tumors, with the latter being more prevalent. Clinical presentation is heterogeneous, with symptoms arising either due to tumor invasion or compression of adjacent neurovascular structures and increased intracranial pressure. Imaging studies are paramount in evaluating pineal region lesions and establishing an accurate diagnosis, with MRI representing the gold standard. Herein, we present the case of a 16-year-old boy presented with recurrent headaches. A head MRI revealed a pineal gland lesion. Histopathological examination confirmed the diagnosis, and the patient underwent a successful gross total resection (GTR) of the tumor. This case report seeks to draw attention to the elusive clinical presentation and management of this infrequently encountered tumor, as well as emphasize the importance of considering pineal gland tumors in the differential diagnosis of recurrent, chronic headaches in pediatric patients.
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12
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MR Imaging of Pediatric Brain Tumors. Diagnostics (Basel) 2022; 12:diagnostics12040961. [PMID: 35454009 PMCID: PMC9029699 DOI: 10.3390/diagnostics12040961] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 02/04/2023] Open
Abstract
Primary brain tumors are the most common solid neoplasms in children and a leading cause of mortality in this population. MRI plays a central role in the diagnosis, characterization, treatment planning, and disease surveillance of intracranial tumors. The purpose of this review is to provide an overview of imaging methodology, including conventional and advanced MRI techniques, and illustrate the MRI appearances of common pediatric brain tumors.
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Paun L, Lavé A, Patet G, Bartoli A. Supratentorial Pediatric Midline Tumors and Tumor-like Lesions: Clinical Spectrum, Natural History and Treatment Options. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040534. [PMID: 35455578 PMCID: PMC9032564 DOI: 10.3390/children9040534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 04/10/2023]
Abstract
Childhood Central Nervous System tumors account for 25% of all pediatric tumors. Large availability and broadening of indications to imaging has made incidental findings more common. Among these, midline lesions have different clinical relevance depending on their intrinsic pattern of behaviour and on their specific location. In this narrative review we describe the natural history and treatment options of midline lesions in children.
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Calandrelli R, Pilato F, Massimi L, Gessi M, Panfili M, Colosimo C. Characterization of high-grade pineal region lesions: the usefulness of apparent diffusion coefficient volumetric values. Acta Radiol 2022; 63:222-231. [PMID: 33497274 DOI: 10.1177/0284185120986912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND High-grade pineal region tumors are rare and heterogeneous types of primary central nervous system neoplasms; radiological differential diagnosis is challenging but it is important because it has a therapeutic relevance. PURPOSE To discriminate among high-grade pineal region tumors by combining apparent diffusion coefficient (ADC) volumetric values and qualitative features in order to predict their histology. MATERIAL AND METHODS Twenty-two patients with high-grade pineal region tumors were assessed by qualitative and quantitative analysis. Margins, T2-weighted signal intensity, contrast enhancement, hemorrhage, calcifications, different volumetric ADC fractions (ADCmean, ADCmax, ADCmin) were evaluated and were compared to the histopathologic findings (cell count and proliferation index). RESULTS Our qualitative imaging data showed that only margins were different among different tumors and each tumor type showed peculiar age onset. ADCmean was found the best quantitative value to discriminate high-grade tumors of the pineal region. ADCmean correlated with proliferation index but not with cell count. ADCmean values were lower in tumors with higher proliferation rate and a significant difference in ADCmean values were found between germinomas and pineoblastomas, between germinomas and papillary tumors and between papillary tumors and pineoblastomas. Moreover, the cut-off value of 0.865 × 10-3 mm2/s for ADCmean (ADC mean threshold value) could differentiate germinoma from pineoblastomas with the best combination of sensitivity and specificity. CONCLUSION The ADCmean value measured on the whole tumor, reflecting tumor proliferative activity, may be a practical and non-invasive marker for predicting tumor histology in high-grade pineal region lesions and might be useful in preoperative assessment.
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Affiliation(s)
- Rosalinda Calandrelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Radiologia e Neuroradiologia, Polo Diagnostica per immagini, radioterapia, oncologia ed ematologia, Area diagnostica per immagini, Rome, Italy
| | - Fabio Pilato
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Neurologia - Polo scienze dell’invecchiamento, neurologiche, ortopediche e della testa-collo, Area Neuroscienze, Rome, Italy
| | - Luca Massimi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Neurochirurgia Infantile - Polo scienze dell’invecchiamento, neurologiche, ortopediche e della testa-collo, Area Neuroscienze, Rome, Italy
- Università Cattolica del Sacro Cuore, Istituto di Neurochirurgia, Rome, Italy
| | - Marco Gessi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Anatomia Patologica- UOS Neuropatologia, Rome, Italy
- Università Cattolica del Sacro Cuore, Istituto di Anatomia Patologica, Rome, Italy
| | - Marco Panfili
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Radiologia e Neuroradiologia, Polo Diagnostica per immagini, radioterapia, oncologia ed ematologia, Area diagnostica per immagini, Rome, Italy
| | - Cesare Colosimo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Radiologia e Neuroradiologia, Polo Diagnostica per immagini, radioterapia, oncologia ed ematologia, Area diagnostica per immagini, Rome, Italy
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
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Neuroimaging of paediatric pineal, sellar and suprasellar tumours: a guide to differential diagnosis. Childs Nerv Syst 2022; 38:33-50. [PMID: 34529090 DOI: 10.1007/s00381-021-05359-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/05/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Pineal, sellar and suprasellar tumours in children comprise a wide range of diseases with different biological behaviours and clinical management. Neuroimaging plays a critical role in the diagnosis, treatment planning and follow up of these patients, but imaging interpretation can prove challenging due to the significant overlap in radiological features. MATERIALS AND METHOD A review of the literature was performed by undertaking a search of the MEDLINE and EMBASE databases for appropriate MeSH terminology. Identified abstracts were screened for inclusion and articles meeting the objectives of the review were included. RESULTS AND CONCLUSION In this article, we review radiological appearances of common and uncommon pineal, sellar and suprasellar tumours occurring in the paediatric population. We discuss the importance of anatomical localization, clinical information and cerebrospinal fluid tumour markers, and propose a practical approach to differential diagnosis. Lastly, we discuss future directions and prospective new imaging strategies to support state-of-the-art patient care.
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Mission impossible: chemotherapy in the intensive care for pineal region germ cell tumor. Childs Nerv Syst 2022; 38:179-183. [PMID: 33474571 DOI: 10.1007/s00381-020-05031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Pineal region tumors are rare and a heterogenous group of primary central nervous system tumors which are primarily classified as germ cell tumors and non-germ cell tumors. Chemotherapy and radiotherapy as the primary treatment modalities have been reported to result in good outcomes. We discuss the case of a young girl who presented to our emergency department in an unconscious state and had a large lesion in the posterior third ventricular region, but without any associated hydrocephalus which could explain her stuporous state. Given the rapid decline in her sensorium, we were faced with the difficult choice between surgical decompression of the tumor and a trial of rescue chemotherapy following histopathological confirmation through biopsy. She underwent an open biopsy followed by chemotherapy in a neurosurgical intensive care unit despite her poor Karnofsky performance score. She improved after chemotherapy and her tumor decreased in size significantly over time. We highlight the role of chemotherapy administered in the neurosurgical ICU to an unconscious patient with a large chemoresponsive tumor leading to rapid shrinkage of the lesion and gradual improvement in the sensorium of the patient.
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Zaccagna F, Brown FS, Allinson KSJ, Devadass A, Kapadia A, Massoud TF, Matys T. In and around the pineal gland: a neuroimaging review. Clin Radiol 2021; 77:e107-e119. [PMID: 34774298 DOI: 10.1016/j.crad.2021.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/30/2021] [Indexed: 01/16/2023]
Abstract
Lesions arising in or around the pineal gland comprise a heterogeneous group of pathologies ranging from benign non-neoplastic cysts to highly malignant neoplasms. Pineal cysts are frequently encountered as an incidental finding in daily radiology practice but there is no universal agreement on the criteria for, frequency of, and duration of follow-up imaging. Solid pineal neoplasms pose a diagnostic challenge owing to considerable overlap in their imaging characteristics, although a combination of radiological appearances, clinical findings, and tumour markers allows for narrowing of the differential diagnosis. In this review, we describe the radiological anatomy of the pineal region, clinical symptoms, imaging appearances, and differential diagnosis of lesions arising in this area, and highlight the clinical management of these conditions.
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Affiliation(s)
- F Zaccagna
- Department of Radiology, University of Cambridge, Cambridge, UK; Division of Neuroimaging, Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - F S Brown
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - K S J Allinson
- Department of Pathology, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - A Devadass
- Department of Pathology, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - A Kapadia
- Division of Neuroimaging, Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - T F Massoud
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - T Matys
- Department of Radiology, University of Cambridge, Cambridge, UK.
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Peng J, Zhou H, Tang O, Chang K, Wang P, Zeng X, Shen Q, Wu J, Xiao Y, Patel SH, Hu C, Jin K, Xiao B, Boxerman J, Gao X, Wen PY, Bai HX, Huang RY, Yang L. Evaluation of RAPNO criteria in medulloblastoma and other leptomeningeal seeding tumors using MRI and clinical data. Neuro Oncol 2021; 22:1536-1544. [PMID: 32215549 DOI: 10.1093/neuonc/noaa072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group has made recommendations for response assessment in patients with medulloblastoma (MBL) and leptomeningeal seeding tumors, these criteria have yet to be evaluated. METHODS We examined MR imaging and clinical data in a multicenter retrospective cohort of 269 patients with MBL diagnoses, high grade glioma, embryonal tumor, germ cell tumor, or choroid plexus papilloma. Interobserver agreement, objective response (OR) rates, and progression-free survival (PFS) were calculated. Landmark analyses were performed for OR and progression status at 0.5, 1.0, and 1.5 years after treatment initiation. Cox proportional hazards models were used to determine the associations between OR and progression with overall survival (OS). Subgroup analyses based on tumor subgroup and treatment modality were performed. RESULTS The median follow-up time was 4.0 years. In all patients, the OR rate was .0.565 (95% CI: 0.505-0.625) by RAPNO. The interobserver agreement of OR determination between 2 raters (a neuroradiologist and a neuro-oncologist) for the RAPNO criteria in all patients was 83.8% (k statistic = 0.815; P < 0.001). At 0.5-, 1.0-, and 1.5-year landmarks, both OR status and PFS determined by RAPNO were predictive of OS (hazard ratios [HRs] for 1-year landmark: OR HR = 0.079, P < 0.001; PFS HR = 10.192, P < 0.001). In subgroup analysis, OR status and PFS were predictive of OS for all tumor subtypes and treatment modalities. CONCLUSION RAPNO criteria showed excellent consistency in the treatment response evaluation of MBL and other leptomeningeal seeding tumors. OR and PFS determined by RAPNO criteria correlated with OS.
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Affiliation(s)
- Jian Peng
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hao Zhou
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Oliver Tang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ken Chang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Panpan Wang
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaowei Zeng
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qin Shen
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jing Wu
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yanhe Xiao
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Sohil H Patel
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Chongyu Hu
- Department of Neurology, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Ke Jin
- Department of Radiology, Hunan Children's Hospital, Changsha, Hunan, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jerrold Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Xiaoping Gao
- Department of Neurology, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Harrison X Bai
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Radiology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Li Yang
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Pineal Gland Tumors: A Review. Cancers (Basel) 2021; 13:cancers13071547. [PMID: 33801639 PMCID: PMC8036741 DOI: 10.3390/cancers13071547] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Pineal neoplasms are tumors with different and variable morphological, histological, and radiological characteristics and, consequently different diagnosis and management. Due to their rarity, pineal tumors may be misdiagnosed. Pineal tumors, are divided into germ cell tumors, pineal parenchymal tumors and tumors that derive from adjacent structures. In this review, we report the clinical relevance of the main pineal gland tumors, underlining the importance of studying the triggering causes of pineal region carcinogenesis, to realize appropriate diagnosis and, consequently, better clinical management. Abstract The pineal gland is a small, pinecone-shaped endocrine gland that participates in the biological rhythm regulation of vertebrates. The recognized major product of the pineal gland is melatonin—a multifunctional endogenous indoleamine. Accumulating evidence suggests that the pineal gland is important for preserving ideal health conditions in vertebrate. Tumors of the pineal region account for approximately 3–11% of pediatric brain neoplasms but fewer than 1% of brain neoplasms in adults. It is fundamental to expand advanced imaging techniques together with both clinical and laboratory knowledge, to help to differentiate among pineal neoplasms and thus facilitate accurate primary diagnoses and proper therapeutic interventions. In this review, we report the gross anatomy of the pineal gland and its functional significance and discuss the clinical relevance of pineal gland tumors, underlining the importance of identifying the leading causes of pineal region masses.
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Shiomi K, Arakawa Y, Minamiguchi S, Yamashita H, Terada Y, Tanji M, Mineharu Y, Umeda K, Uto M, Takita J, Haga H, Mizowaki T, Miyamoto S. Mixed germ cell tumor infiltrating the pineal gland without elevated tumor markers: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 1:CASE20131. [PMID: 35854926 PMCID: PMC9241350 DOI: 10.3171/case20131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/11/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Tumors in the pineal region consist of various histological types, and correct diagnosis from biopsy specimens is sometimes difficult. The authors report the case of a patient with a mixed germ cell tumor infiltrating into the pineal gland despite showing no elevation of tumor markers. OBSERVATIONS An 18-year-old man complained of headache and nausea and showed disturbance of consciousness. Magnetic resonance imaging showed hydrocephalus associated with a cystic pineal tumor. The patient underwent tumor biopsy followed by endoscopic third ventriculostomy for hydrocephalus in a local hospital. A pineocytoma was diagnosed, and the patient was referred to the authors' hospital for treatment. Concentrations of placental alkaline phosphatase, alpha-fetoprotein (AFP), and beta-human chorionic gonadotropin in cerebrospinal fluid were not elevated. However, the authors' review of the tumor specimen revealed some immature cells infiltrating the pineal gland. These cells were positive for AFP, Sal-like protein 4, and octamer-binding transcription factor 3/4; and the diagnosis was changed to mixed germ cell tumor. Chemoradiotherapy was initiated, followed by surgical removal of the residual tumor. LESSONS Careful examination of all tumor specimens and immunohistochemical analyses are important for accurate diagnosis of pineal tumors.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Megumi Uto
- Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | - Takashi Mizowaki
- Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
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21
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Kanamori M, Takami H, Yamaguchi S, Sasayama T, Yoshimoto K, Tominaga T, Inoue A, Ikeda N, Kambe A, Kumabe T, Matsuda M, Tanaka S, Natsumeda M, Matsuda KI, Nonaka M, Kurihara J, Yamaoka M, Kagawa N, Shinojima N, Negoto T, Nakahara Y, Arakawa Y, Hatazaki S, Shimizu H, Yoshino A, Abe H, Akimoto J, Kawanishi Y, Suzuki T, Natsume A, Nagane M, Akiyama Y, Keino D, Fukami T, Tomita T, Kanaya K, Tokuyama T, Izumoto S, Nakada M, Kuga D, Yamamoto S, Anei R, Uzuka T, Fukai J, Kijima N, Terashima K, Ichimura K, Nishikawa R. So-called bifocal tumors with diabetes insipidus and negative tumor markers: are they all germinoma? Neuro Oncol 2021; 23:295-303. [PMID: 32818237 PMCID: PMC7906060 DOI: 10.1093/neuonc/noaa199] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Delphi consensus statements on the management of germ cell tumors (GCTs) failed to reach agreements on the statement that the cases with (i) pineal and neurohypophyseal bifocal lesion, (ii) with diabetes insipidus, and (iii) with negative tumor markers can be diagnosed as germinoma without histological verification. To answer this, multicenter retrospective analysis was performed. METHODS A questionnaire on clinical findings, histological diagnosis, and details of surgical procedures was sent to 86 neurosurgical and 35 pediatrics departments in Japan. RESULTS Fifty-one institutes reported 132 cases that fulfilled the 3 criteria. Tissue sampling was performed in 91 cases from pineal (n = 44), neurohypophyseal (n = 32), both (n = 6), and distant (n = 9) lesions. Histological diagnosis was established in 89 cases: pure germinoma or germinoma with syncytiotrophoblastic giant cells in 82 (92.1%) cases, germinoma and mature teratoma in 2 cases, and granulomatous inflammation in 2 cases. Histological diagnosis was not established in 2 cases. Although no tumors other than GCTs were identified, 3 (3.4%) patients had non-germinomatous GCTs (NGGCTs). None of the patients developed permanent complications after endoscopic or stereotactic biopsy. Thirty-nine patients underwent simultaneous procedure for acute hydrocephalus without permanent complications, and hydrocephalus was controlled in 94.9% of them. CONCLUSION All patients who fulfilled the 3 criteria had GCTs or granulomatous inflammation, but not other types of tumors. However, no fewer than 3.4% of the patients had NGGCTs. Considering the safety and the effects of simultaneous procedures for acute hydrocephalus, biopsy was recommended in such patients.
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Affiliation(s)
- Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirokazu Takami
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shigeru Yamaguchi
- Department of Neurosurgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akihiro Inoue
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Naokado Ikeda
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Osaka, Japan
| | - Atsushi Kambe
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shota Tanaka
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Ken-Ichiro Matsuda
- Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Masahiro Nonaka
- Department of Neurosurgery, Kansai Medical University, Osaka, Japan
| | - Jun Kurihara
- Department of Neurosurgery, Saitama Children’s Medical Center, Saitama, Japan
| | - Masayoshi Yamaoka
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Kagawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoki Shinojima
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Tetsuya Negoto
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Yukiko Nakahara
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Seiji Hatazaki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Hiroaki Shimizu
- Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Atsuo Yoshino
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University, Fukuoka, Japan
| | - Jiro Akimoto
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - Yu Kawanishi
- Department of Neurosurgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Atsushi Natsume
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Dai Keino
- Division of Hematology/Oncology, Kanagawa Children`s Medical Center, Yokohama, Japan
| | - Tadateru Fukami
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takahiro Tomita
- Department of Neurosurgery, University of Toyama, Toyama, Japan
| | - Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tsutomu Tokuyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shuichi Izumoto
- Department of Neurosurgery, Kindai University Faculty of Medicine, Sayama, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Daisuke Kuga
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shohei Yamamoto
- Department of Pediatrics, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Ryogo Anei
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
| | - Takeo Uzuka
- Department of Neurosurgery, Dokkyo Medical University, Tochigi, Japan
| | - Junya Fukai
- Department of Neurological Surgery, Wakayama Medical University School of Medicine Wakayama, Japan
| | - Noriyuki Kijima
- Department of Neurosurgery, Osaka National Hospital, Osaka, Japan
| | - Keita Terashima
- Division of Neuro-Oncology, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
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22
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Takano M, Kinoshita Y, Sugiyama K, Kolakshyapati M, Takayasu T, Yonezawa U, Taguchi A, Akiyama Y, Amatya VJ, Takeshima Y, Kurisu K, Yamasaki F. Detecting non-germinomatous germ cell tumor component by arterial spin labeling perfusion-weighted MR imaging in central nervous system germ cell tumor. Eur J Radiol 2021; 136:109523. [PMID: 33460957 DOI: 10.1016/j.ejrad.2021.109523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/24/2020] [Accepted: 01/03/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Differentiating between germinoma and non-germinomatous germ cell tumor (NGGCT) is important because sensitivity to chemotherapy and/or radiotherapy is quite different between these two subgroups. In this study, we evaluated whether the arterial spin labeling (ASL) based perfusion-weighted imaging (PWI) could provide additional information for the differential diagnosis between germinoma and NGGCT. METHOD Between 2011 and 2018, 20 patients with central nervous system (CNS) germ cell tumor (GCT) who underwent preoperative MR imaging including ASL-PWI were enrolled in this study. Relative tumor blood flow (rTBF) was evaluated on ASL-PWI by manually placing regions of interest at gadolinium enhanced part of the tumors and normal subcortical white matter. Presence of intratumoral T1 hyperintense foci and apparent diffusion coefficient (ADC) were also evaluated. The final diagnosis was made by the combination of tumor markers and the histological diagnosis. RESULTS Among 20 patients of CNS-GCT, 11 were diagnosed as germinoma and 9 were diagnosed as NGGCT. In the germinoma subgroup, the rTBF ranged from 0.90 to 1.71 (mean 1.21, median 1.09), while it ranged from 1.14 to 5.75 (mean 3.91, median 3.31) in NGGCT subgroup. The receiver operating characteristic (ROC) curve showed that calculating rTBF is useful for differentiating between germinoma and NGGCT (area under the curve (AUC) 0.929, P = 0.0012) compared to intratumoral T1 hyperintense foci (AUC 0.788, P = 0.0304) and ADC (AUC 0.919, P = 0.0016). CONCLUSIONS High rTBF obtained by ASL-PWI implied the presence of NGGCT component. This information might help in deciding the chemotherapy/radiotherapy intensity.
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Affiliation(s)
- Motoki Takano
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yasuyuki Kinoshita
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology & Neuro-oncology Program, Hiroshima University Hospital, Hiroshima 734-8551, Japan
| | - Manish Kolakshyapati
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; Department of Neurosurgery, B & B Hospital, Gwarko, Lalitpur, Nepal
| | - Takeshi Takayasu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Ushio Yonezawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Akira Taguchi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuji Akiyama
- Department of Clinical Radiology, Hiroshima University, Hiroshima 734-8551, Japan
| | - Vishwa Jeet Amatya
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Kaoru Kurisu
- Director, Chugoku Rosai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima 737-0193, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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Doostkam S, Würtemberger U, Coenen V, Urbach H, Prinz M, Taschner CA. Freiburg Neuropathology Case Conference: : Blurred Vision and Headaches in a 15-year-old Boy. Clin Neuroradiol 2020; 30:879-884. [PMID: 33230629 PMCID: PMC7728650 DOI: 10.1007/s00062-020-00973-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S Doostkam
- Department of Neuropathology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - U Würtemberger
- Department of Neuroradiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - V Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.
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24
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Damgacı L, Hayat B, Güreşçi S. Papillary Tumor of the Pineal Region with Parinaud Syndrome: A Case Report. Curr Med Imaging 2020; 16:1044-1047. [PMID: 33081665 DOI: 10.2174/1573405615666191111143716] [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: 03/24/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 11/22/2022]
Abstract
Backround: Less than 1% of all intracranial tumors are in the pineal region. Papillary tumor of the pineal region is considered one of four pineal parenchymal tumors according to the 2007 World Health Organisation classification of central nervous system tumors. It is mostly seen in the middle age and it is rare under the age of 17 in the literature. In this report, we aim to present a case with papillary tumor of the pineal region with both CT and MRI findings, and discuss the differential diagnosis. Case report: A 17-year-old female patient who underwent a treatment of ventriculoperitoneal shunt due to hydrocephalus 18 months ago applied to the neurosurgery clinic with nausea, vomiting, sensorineural hearing loss and Parinaud syndrome continuing through 1 month. Computed tomography (CT) and magnetic resonance imaging (MRI) have been applied. A 58x31x38 mm mass with cystic and mild hyperdense soft tissue components was observed in the localization of pineal gland and posterior comissure on non-enhanced CT. MRI examination revealed that the mass filled the pineal region, contained solid and large cystic components, and hyperintense on T1-weighted images. After intravenous contrast media injection, the mass enhanced more peripherally. DW-MRI showed that there is a diffusion restriction in some parts of the soft tissue components. The mass was totally resected, and pathology report revealed that it is a papillary tumor of the pineal region. Conclusion: When a T1-weighted hyperintense and CT hyperdense mass with cystic and solid components is seen in the pineal region, even if it is rare, papillary tumor should also be considered in the differential diagnosis after exclusion of other hyperintense lesions in T1-weighted imaging.
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Affiliation(s)
- Lale Damgacı
- Department of Radiology, Ankara Numune Training and Researching Hospital, Ankara, Turkey
| | - Büşra Hayat
- Department of Radiology, Ankara Numune Training and Researching Hospital, Ankara, Turkey
| | - Servet Güreşçi
- Department of Pathology, Ankara Numune Training and Researching Hospital, Ankara, Turkey
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25
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Patel S, Rahmani B, Gandhi J, Seyam O, Joshi G, Reid I, Smith NL, Waltzer WC, Khan SA. Revisiting the pineal gland: a review of calcification, masses, precocious puberty, and melatonin functions. Int J Neurosci 2020; 130:464-475. [PMID: 31714865 DOI: 10.1080/00207454.2019.1692838] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: The pineal gland, an endocrine organ of the posterior cranial fossa famously involved in sleep and wakefulness, has continually been a topic of scientific advancement and curiosity. Methods: We review present an up-to-date review including the anatomy, embryology, and physiology of the pineal gland and its ability to secrete hormones including melatonin, pathophysiology of pineal gland tumors, cysts, and calcifications, their clinical presentation including their association with parkinsonism and precocious puberty, and various treatment approaches. Results: Exploring the biochemistry of melatonin, various calcification morphologies, and pineal tumors may uncover a wider role and the exhaustive case study consolidation allows clinicians to carefully review the literature and aid their treatment approaches. Conclusion: It is imperative that clinicians and diagnosticians are able to distinguish manifestations of an overlooked gland.
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Affiliation(s)
- Shrey Patel
- Department of Physiology and Biophysics, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Benjamin Rahmani
- Department of Physiology and Biophysics, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA.,Medical Student Research Institute, St. George's University School of Medicine, Grenada, West Indies
| | - Omar Seyam
- Department of Physiology and Biophysics, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, NY, USA
| | - Inefta Reid
- Department of Physiology and Biophysics, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | | | - Wayne C Waltzer
- Department of Urology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA.,Department of Urology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
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26
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Qureshi S, Francis JH, Haque SS, Dunkel IJ, Souweidane MM, Friedman DN, Abramson DH. Magnetic Resonance Imaging Screening for Trilateral Retinoblastoma: The Memorial Sloan Kettering Cancer Center Experience 2006-2016. Ophthalmol Retina 2019; 4:327-335. [PMID: 31948910 DOI: 10.1016/j.oret.2019.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/13/2019] [Accepted: 10/21/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE Magnetic resonance imaging (MRI) has been used for baseline brain imaging and afterward as a screening tool for trilateral retinoblastoma (TRB), but there is no consensus on timing or frequency of screening worldwide. In this study, a cohort of hereditary retinoblastoma patients at increased risk for TRB was identified and the usefulness of aggressive neuroimaging was examined. DESIGN Retrospective review of the medical records and MRI reports of patients with retinoblastoma treated at Memorial Sloan Kettering Cancer Center between January 1, 2006, and December 31, 2016. PARTICIPANTS Three hundred forty-nine total patients with retinoblastoma, including 215 hereditary retinoblastoma patients in the screening group. METHODS We reviewed 804 MRI studies of the orbit or brain. Patient and disease characteristics, including laterality, family history, and gene mutation status were analyzed. The impression of every MRI was coded 1 to 5, each value representing a different abnormality. MAIN OUTCOME MEASURES We calculated the incidence of TRB in patients with germline disease as well as the incidence of screening MRI scans showing TRB. RESULTS Among our hereditary retinoblastoma screening cohort (n=215) 4 patients with TRB were identified on screening MRI. All 4 patients showed bilateral disease, pineal gland tumors, and a latency period of at least 1 year. Three of the 4 were deceased by the end of the study. The incidence of TRB diagnosis was 1.9% (95% confidence interval [CI], 0.7%-4.9%). Of the 804 screening MRI scans performed on the screening cohort, 691 (86%) were unremarkable and 4 reported a lesion suspicious for TRB. The overall incidence of detecting TRB on screening MRI in the at-risk cohort was 0.5% (95% CI, 0.2%-1.3%) with a number needed to treat of 202. CONCLUSIONS All cases of TRB in our center during the study period developed before the patient was 3 years of age and after a total of only 4 lifetime MRIs. Overall survival from TRB was not improved as a result of screening, and many false-positive results required additional, subsequent MRI scans with anesthesia.
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Affiliation(s)
- Sana Qureshi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Jasmine H Francis
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Ophthalmology, Weill Cornell Medical School, New York, New York
| | - Sofia S Haque
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ira J Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Mark M Souweidane
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Danielle N Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David H Abramson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Ophthalmology, Weill Cornell Medical School, New York, New York
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Jaju A, Hwang EI, Kool M, Capper D, Chavez L, Brabetz S, Billups C, Li Y, Fouladi M, Packer RJ, Pfister SM, Olson JM, Heier LA. MRI Features of Histologically Diagnosed Supratentorial Primitive Neuroectodermal Tumors and Pineoblastomas in Correlation with Molecular Diagnoses and Outcomes: A Report from the Children's Oncology Group ACNS0332 Trial. AJNR Am J Neuroradiol 2019; 40:1796-1803. [PMID: 31601576 DOI: 10.3174/ajnr.a6253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/21/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Supratentorial primitive neuroectodermal tumors and pineoblastomas have traditionally been grouped together for treatment purposes. Molecular profiling of these tumors has revealed a number of distinct entities and has led to the term "CNS-primitive neuroectodermal tumors" being removed from the 2016 World Health Organization classification. The purpose of this study was to describe the MR imaging findings of histologically diagnosed primitive neuroectodermal tumors and pineoblastomas and correlate them with molecular diagnoses and outcomes. MATERIALS AND METHODS Histologically diagnosed primitive neuroectodermal tumors and pineoblastomas were enrolled in this Children's Oncology Group Phase III trial, and molecular classification was retrospectively completed using DNA methylation profiling. MR imaging features were systematically studied and correlated with molecular diagnoses and survival. RESULTS Of the 85 patients enrolled, 56 met the inclusion criteria, in whom 28 tumors were in pineal and 28 in nonpineal locations. Methylation profiling revealed a variety of diagnoses, including pineoblastomas (n = 27), high-grade gliomas (n = 17), embryonal tumors (n = 7), atypical teratoid/rhabdoid tumors (n = 3), and ependymomas (n = 2). Thus, 39% overall and 71% of nonpineal tumor diagnoses were discrepant with histopathology. Tumor location, size, margins, and edema were predictors of embryonal-versus-nonembryonal tumors. Larger size and ill-defined margins correlated with poor event-free survival, while metastatic disease by MR imaging did not. CONCLUSIONS In nonpineal locations, only a minority of histologically diagnosed primitive neuroectodermal tumors are embryonal tumors; therefore, high-grade glioma or ependymoma should be high on the radiographic differential. An understanding of molecularly defined tumor entities and their relative frequencies and locations will help the radiologist make more accurate predictions of the tumor types.
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Affiliation(s)
- A Jaju
- From the Department of Radiology (A.J.), Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois .,Northwestern University Feinberg School of Medicine (A.J.), Chicago, Illinois
| | - E I Hwang
- Brain Tumor Institute (E.I.H., R.J.P.), Children's National Health System, Washington, DC
| | - M Kool
- Department of Pediatric Neurooncology (M.K., S.B., S.M.P.), German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany
| | - D Capper
- Department of Pediatric Neuropathology (D.C.), University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - L Chavez
- Department of Medicine (L.C.), University of California San Diego, La Jolla, California
| | - S Brabetz
- Department of Pediatric Neurooncology (M.K., S.B., S.M.P.), German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany
| | - C Billups
- Department of Biostatistics (C.B., Y.L.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Y Li
- Department of Biostatistics (C.B., Y.L.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - M Fouladi
- Brain Tumor Center (M.F.), Cincinnati Children's Hospital, Cincinnati, Ohio
| | - R J Packer
- Brain Tumor Institute (E.I.H., R.J.P.), Children's National Health System, Washington, DC
| | - S M Pfister
- Department of Pediatric Neurooncology (M.K., S.B., S.M.P.), German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany
| | - J M Olson
- Fred Hurtchinson Cancer Research Center (J.M.O.), Seattle Children's Hospital, Seattle, Washington
| | - L A Heier
- Department of Radiology (L.A.H.), New York Presbyterian Hospital, New York, New York
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28
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Giordano M, Samii A, Samii M, Nabavi A. Magnetic Resonance Imaging-Apparent Diffusion Coefficient Assessment of Vestibular Schwannomas: Systematic Approach, Methodology, and Pitfalls. World Neurosurg 2019; 125:e820-e823. [PMID: 30738940 DOI: 10.1016/j.wneu.2019.01.176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the validity of various approaches to extract quantitative measurements of diffusion imaging (i.e., apparent diffusion coefficient [ADC]) to investigate tumors of the central nervous system. In current studies, the region of interest (ROI) for the quantitative measurements are placed arbitrarily according to morphology. Our aim is to investigate how placement patterns influence the ADC estimation in intracranial tumors. METHODS Twenty consecutive patients affected by vestibular schwannoma were studied using diffusion imaging. ADC values were obtained using different ROI placement methods: segmentation ADC values of the entire volume (vADC), random ADC values were obtained in 10 different ROI points, and a single ROI in the ADC of the internal auditory canal portion of the tumor. RESULTS ADC of the internal auditory canal portion of the tumor and vADC differed significantly (P < 0.01). vADC was different between cystic and microcystic schwannomas (P = 0.009) and between cystic and solid schwannomas (P = 0.006). CONCLUSIONS The positioning of ROI in these measurements is pivotal. Although "whole tumor volume" measurements represent the largest amount of information, multiple seed points can be used as well. However, there must be multiple seeds and their placement must be reported. ADC can be used as a versatile tool for tumor assessment but must be used judiciously and structured to yield comparable results.
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Affiliation(s)
- Mario Giordano
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany.
| | - Amir Samii
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Madjid Samii
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany
| | - Arya Nabavi
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany
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29
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Pediatric Tumor Neuroradiology. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Bisdas S, D’Arco F. Pediatric Tumor Neuroradiology. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-61423-6_36-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Bisdas S, D’Arco F. Pediatric Tumor Neuroradiology. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-61423-6_36-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Tian Y, Liu R, Qin J, Wang J, Ma Z, Gong J, Li C. Retrospective Analysis of the Clinical Characteristics, Therapeutic Aspects, and Prognostic Factors of 18 Cases of Childhood Pineoblastoma. World Neurosurg 2018; 116:e162-e168. [PMID: 29709740 DOI: 10.1016/j.wneu.2018.04.135] [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: 12/24/2017] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pineoblastoma is a rare malignant tumor of the pineal gland, which is more common in children. METHODS We retrospectively reviewed 18 cases of pineoblastoma in children (10 girls), including general, clinical, and therapeutic information, and factors affecting prognosis. RESULTS The median age of the children was 51.7 months (range, 19-156 months). Presenting symptoms included vomiting (64.70%), headache (47.06%), weak or unsteady walking (35.29%), and nausea (29.41%). Rarer symptoms (1 patient each) included limb rigidity, inability to speak, double vision, fever, and Parinaud syndrome. Five and 13 children, respectively, underwent subtotal and gross total resection; 5 and 13 children received adjuvant craniospinal irradiation therapy and chemotherapy. Two children received both craniospinal irradiation and chemotherapy. The 5-year overall survival of the patients was 27.8% (5/18). The survival rate of children older than 4 years (66.7%) was significantly higher than that of younger children (8.3%). The 5-year overall survival rate of boys (50.7%) was higher than that of girls (10.0%); that of children who underwent gross total resection (30.8%) was higher than that of children who underwent subtotal resection (20.0%); and that of children treated with adjuvant craniospinal irradiation (50.7%) was higher than that of those not given craniospinal irradiation (10.0%). However, in each of these 3 comparisons the differences were not significant. CONCLUSION Pineoblastoma is rare but often fatal, especially in children younger than 4 years. Survival rates tend to be higher in boys, children undergoing gross total resection (rather than subtotal), and those given craniospinal irradiation.
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Affiliation(s)
- Yongji Tian
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center for Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory for Brain Tumor, Beijing, China
| | - Raynald Liu
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center for Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory for Brain Tumor, Beijing, China
| | - Junji Qin
- Department of Neuropathology, Beijing Neurosurgical Institute, Beijing, China
| | - Junmei Wang
- Department of Neuropathology, Beijing Neurosurgical Institute, Beijing, China
| | - Zhenyu Ma
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center for Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory for Brain Tumor, Beijing, China
| | - Jian Gong
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center for Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory for Brain Tumor, Beijing, China
| | - Chunde Li
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center for Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory for Brain Tumor, Beijing, China.
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Proton Magnetic Resonance Spectroscopy Detection of High Lipid Levels and Low Apparent Diffusion Coefficient Is Characteristic of Germinomas. World Neurosurg 2018; 112:e84-e94. [DOI: 10.1016/j.wneu.2017.12.078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 01/23/2023]
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34
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The Child With Macrocephaly: Differential Diagnosis and Neuroimaging Findings. AJR Am J Roentgenol 2018; 210:848-859. [DOI: 10.2214/ajr.17.18693] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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35
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Choudhri AF, Cohen HL, Siddiqui A, Pande V, Blitz AM. Twenty-Five Diagnoses on Midline Images of the Brain: From Fetus to Child to Adult. Radiographics 2018; 38:218-235. [PMID: 29320328 DOI: 10.1148/rg.2018170019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Midsagittal images of the brain provide a wealth of anatomic information and may show abnormalities that are pathognomonic for particular diagnoses. Using an anatomy-based approach, the authors identify pertinent anatomic structures to serve as a checklist when evaluating these structures. Subregions evaluated include the corpus callosum, pituitary gland and sellar region, pineal gland and pineal region, brainstem, and cerebellum. The authors present 25 conditions with characteristic identifiable abnormalities at midsagittal imaging. Midsagittal views from multiple imaging modalities are shown, including computed tomography, ultrasonography, and magnetic resonance (MR) imaging. Standard MR imaging sequences are shown, as well as fetal MR and sagittal diffusion-weighted images. To demonstrate these conditions, fetal, neonatal, childhood, adolescent, and young adulthood images are reviewed. The differentiation of normal variants is guided by the understanding of anatomy and pathology. When a specific diagnosis is not possible, the authors present information to evaluate differential considerations and discuss when follow-up imaging may be indicated. The authors hope each case will clarify a pertinent differential diagnosis, appropriately guide patient management, and improve understanding of normal anatomy and identification of pathologic entities. It is in these hopes that the authors have presented a checklist of pertinent anatomy and pathologic entities that can build on existing search patterns. Improved confidence and accuracy in the evaluation of midsagittal images will benefit physicians and patients. ©RSNA, 2018.
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Affiliation(s)
- Asim F Choudhri
- From the Department of Radiology, Le Bonheur Children's Hospital, 848 Adams Ave, G216, Memphis, TN 38103 (A.F.C., H.L.C., A.S., V.P.); Departments of Radiology (A.F.C., H.L.C., A.S., V.P.), Neurosurgery (A.F.C.), Ophthalmology (A.F.C.), Pediatrics (H.L.C.), and Obstetrics (H.L.C.), University of Tennessee Health Science Center, Memphis, Tenn; and Department of Radiology, Johns Hopkins University, Baltimore, Md (A.M.B.)
| | - Harris L Cohen
- From the Department of Radiology, Le Bonheur Children's Hospital, 848 Adams Ave, G216, Memphis, TN 38103 (A.F.C., H.L.C., A.S., V.P.); Departments of Radiology (A.F.C., H.L.C., A.S., V.P.), Neurosurgery (A.F.C.), Ophthalmology (A.F.C.), Pediatrics (H.L.C.), and Obstetrics (H.L.C.), University of Tennessee Health Science Center, Memphis, Tenn; and Department of Radiology, Johns Hopkins University, Baltimore, Md (A.M.B.)
| | - Adeel Siddiqui
- From the Department of Radiology, Le Bonheur Children's Hospital, 848 Adams Ave, G216, Memphis, TN 38103 (A.F.C., H.L.C., A.S., V.P.); Departments of Radiology (A.F.C., H.L.C., A.S., V.P.), Neurosurgery (A.F.C.), Ophthalmology (A.F.C.), Pediatrics (H.L.C.), and Obstetrics (H.L.C.), University of Tennessee Health Science Center, Memphis, Tenn; and Department of Radiology, Johns Hopkins University, Baltimore, Md (A.M.B.)
| | - Vijay Pande
- From the Department of Radiology, Le Bonheur Children's Hospital, 848 Adams Ave, G216, Memphis, TN 38103 (A.F.C., H.L.C., A.S., V.P.); Departments of Radiology (A.F.C., H.L.C., A.S., V.P.), Neurosurgery (A.F.C.), Ophthalmology (A.F.C.), Pediatrics (H.L.C.), and Obstetrics (H.L.C.), University of Tennessee Health Science Center, Memphis, Tenn; and Department of Radiology, Johns Hopkins University, Baltimore, Md (A.M.B.)
| | - Ari M Blitz
- From the Department of Radiology, Le Bonheur Children's Hospital, 848 Adams Ave, G216, Memphis, TN 38103 (A.F.C., H.L.C., A.S., V.P.); Departments of Radiology (A.F.C., H.L.C., A.S., V.P.), Neurosurgery (A.F.C.), Ophthalmology (A.F.C.), Pediatrics (H.L.C.), and Obstetrics (H.L.C.), University of Tennessee Health Science Center, Memphis, Tenn; and Department of Radiology, Johns Hopkins University, Baltimore, Md (A.M.B.)
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36
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Solomou AG. Magnetic resonance imaging of pineal tumors and drop metastases: a review approach. Rare Tumors 2017; 9:6715. [PMID: 29142658 PMCID: PMC5661140 DOI: 10.4081/rt.2017.6715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/26/2016] [Accepted: 10/01/2016] [Indexed: 11/24/2022] Open
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37
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MRI features of pediatric intracranial germ cell tumor subtypes. J Neurooncol 2017; 134:221-230. [PMID: 28551848 DOI: 10.1007/s11060-017-2513-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 05/23/2017] [Indexed: 12/13/2022]
Abstract
Intracranial germ cell tumors differ in histology and location, and require different clinical management strategies. We characterized the imaging features that may aid pre-operative differentiation of intracranial germinomas and non-germinomatous germ cell tumors (NGGCTs). This retrospective study analyzed 85 patients with intracranial germ cell tumors and adequate preoperative or pretreatment MRIs between 2000 and 2013 at our institution. Pretreatment MRI characteristics, apparent diffusion coefficient (ADC) values, tumor histopathology, and patient outcomes were compared. NGGCTs occurred in the pineal region and cerebral hemispheres more often than germinomas; all bifocal lesions were germinomas. NGGCTs (36.6 ± 17.0 mm) were significantly larger than germinomas (25.7 ± 11.6 mm; P = 0.002). The presence of pure solid tumor (45.5 vs. 20.0%, P = 0.033) and an infiltrative margin (20.0 vs. 3.3%, P = 0.035) were significantly more common in germinomas than NGGCTs. The presence of intratumoral T1 hyperintense foci (66.7 vs. 10.9%, P < 0.001) and moderate/marked enhancement (86.7 vs. 50.9%, P < 0.001) were significantly more common in NGGCTs than in germinomas. Mean ADCmean values (×10-3 mm2/s) were significantly lower in germinomas (1.113 ± 0.415) than in NGGCTs (2.011 ± 0.694, P = 0.001). Combined a lack of T1 hyperintense foci and an ADCmean threshold value (1.143 × 10-3 mm2/s) had the highest specificity (91.3%) and positive predictive value (92.3%), while the combination of lack of a T1 hyperintensense foci, no/mild enhancement, and an ADCmean threshold value had 100% sensitivity and 100% negative-predictive value for discriminating germinomas from NGGCTs. Pre-operative conventional MRI characteristics and diffusion-weighted MRI help clinicians to assess patients with intracranial germ cell tumors. Tumor size, location, T1 hyperintense foci, intratumoral cystic components, tumor margin and enhancing patterns demonstrate contrast between germinomas and NGGCTs. Serum tumor markers and adjunctive combination with T1 hyperintensity and/or enhancing pattern with ADC offer potential in preoperative differentiating intracranial germinomas and NGGCTs.
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Abstract
A review of pediatric pineal region tumors is provided with emphasis on advanced imaging techniques. The 3 major categories of pineal region tumors include germ cell tumors, pineal parenchymal tumors, and tumors arising from adjacent structures such as tectal astrocytomas. The clinical presentation, biochemical markers, and imaging of these types of tumors are reviewed.
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Adams LC, Böker SM, Bender YY, Diederichs G, Fallenberg EM, Wagner M, Hamm B, Makowski MR. Diagnostic accuracy of susceptibility-weighted magnetic resonance imaging for the evaluation of pineal gland calcification. PLoS One 2017; 12:e0172764. [PMID: 28278291 PMCID: PMC5344338 DOI: 10.1371/journal.pone.0172764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/09/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives To determine the diagnostic performance of susceptibility-weighted magnetic resonance imaging (SWMR) for the detection of pineal gland calcifications (PGC) compared to conventional magnetic resonance imaging (MRI) sequences, using computed tomography (CT) as a reference standard. Methods 384 patients who received a 1.5 Tesla MRI scan including SWMR sequences and a CT scan of the brain between January 2014 and October 2016 were retrospectively evaluated. 346 patients were included in the analysis, of which 214 showed PGC on CT scans. To assess correlation between imaging modalities, the maximum calcification diameter was used. Sensitivity and specificity and intra- and interobserver reliability were calculated for SWMR and conventional MRI sequences. Results SWMR reached a sensitivity of 95% (95% CI: 91%-97%) and a specificity of 96% (95% CI: 91%-99%) for the detection of PGC, whereas conventional MRI achieved a sensitivity of 43% (95% CI: 36%-50%) and a specificity of 96% (95% CI: 91%-99%). Detection rates for calcifications in SWMR and conventional MRI differed significantly (95% versus 43%, p<0.001). Diameter measurements between SWMR and CT showed a close correlation (R2 = 0.85, p<0.001) with a slight but not significant overestimation of size (SWMR: 6.5 mm ± 2.5; CT: 5.9 mm ± 2.4, p = 0.02). Interobserver-agreement for diameter measurements was excellent on SWMR (ICC = 0.984, p < 0.0001). Conclusions Combining SWMR magnitude and phase information enables the accurate detection of PGC and offers a better diagnostic performance than conventional MRI with CT as a reference standard.
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Affiliation(s)
- Lisa C. Adams
- Department of Radiology, Charité, Berlin, Germany
- * E-mail:
| | | | | | | | | | | | - Bernd Hamm
- Department of Radiology, Charité, Berlin, Germany
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Inoue A, Ohnishi T, Kohno S, Ohue S, Iwata S, Matsumoto S, Nishikawa M, Ozaki S, Mizuno Y, Kitazawa R, Kunieda T. Identification of characteristic features of pineal germinoma that enhance accuracy of preoperative differentiation in pineal region tumors: its significance on optimum surgical treatment. Neurosurg Rev 2017; 41:197-206. [PMID: 28247123 DOI: 10.1007/s10143-017-0835-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/06/2016] [Accepted: 02/20/2017] [Indexed: 11/24/2022]
Abstract
The aim of the study is to identify characteristic features of pineal germinoma that enhance preoperative accuracy in differentiating germinoma from other pineal region tumors. Twenty-one consecutive patients with pineal region tumors were enrolled. In all patients, tumor resection was performed to verify the histology. Clinical records including upward gaze palsy of Parinaud's syndrome and neuroimaging were analyzed. In addition, we evaluated the relationship between magnetic resonance imaging (MRI) findings and tumor progression patterns in pineal germinoma. Among 21 patients, 15 patients were diagnosed with germ cell tumor, 4 with pineal parenchymal cell tumor, and 2 with meningioma. Upward gaze palsy was seen in 11 patients; nine had pure germinomas and two had mixed germ cell tumors. These tumors occupied the pineal region with extension to the area of the mesodiencephalic junction (MDJ) and the bi-epithalamic area between the bilateral pulvinar and the third ventricle. Tumor involvement of the former area could cause upward gaze palsy by insulting the rostral interstitial nucleus of the medial longitudinal fasciculus located in the MDJ area. Tumor invasion into the latter area is commonly seen as a cardioid-shaped tumor as the tumor image on the axial MRI view. Upward gaze palsy and a cardioid-shaped tumor image on the axial MRI views were demonstrated to be specific features of pineal pure germinoma. It is suggested that combination of both features may become useful tools to preoperatively differentiate germinoma from other pineal tumors, resulting in achievement of the optimum treatment of pineal region tumors.
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Affiliation(s)
- Akihiro Inoue
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Takanori Ohnishi
- Department of Neurosurgery, Washoukai Sadamoto Hospital, 1-6-1 Takehara, Matsuyama, Ehime, 790-0052, Japan
| | - Shohei Kohno
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Shiro Ohue
- Department of Neurosurgery, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Shinji Iwata
- Department of Neurosurgery, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Shirabe Matsumoto
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Masahiro Nishikawa
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Saya Ozaki
- Department of Neurosurgery, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Yosuke Mizuno
- Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Riko Kitazawa
- Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
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Yoon DJ, Park J, Lezama LM, Heller GD. Pineal parenchymal tumour of intermediate differentiation: a rare differential diagnosis of pineal region tumours. BJR Case Rep 2016; 2:20150371. [PMID: 30460022 PMCID: PMC6243328 DOI: 10.1259/bjrcr.20150371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 02/17/2016] [Accepted: 03/17/2016] [Indexed: 11/05/2022] Open
Abstract
Pineal parenchymal tumours of intermediate differentiation are a rare type of pineal parenchymal tumours. As indicated by their name, these tumours fall between pineoblastoma (a malignant pineal parenchymal tumour) and pineocytoma (a benign pineal parenchymal tumour). In this article, we present a case of pineal parenchymal tumour of intermediate differentiation that was successfully treated by resection via the supracerebellar approach. We also discuss the differential consideration based on epidemiological, pathological and radiological findings.
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Affiliation(s)
- Daniel J Yoon
- Department of Radiology, Mount Sinai West Hospital Center of the Icahn School of Medicine, New York, NY, USA
| | - James Park
- Department of Radiology, Mount Sinai West Hospital Center of the Icahn School of Medicine, New York, NY, USA
| | - Lhara M Lezama
- Department of Pathology, Mount Sinai West Hospital Center of the Icahn School of Medicine, New York, NY, USA
| | - Gordon D Heller
- Department of Radiology, Mount Sinai West Hospital Center of the Icahn School of Medicine, New York, NY, USA
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Endoscopic Histologic Mapping of a Mixed Germ Pineal Tumor. World Neurosurg 2016; 95:625.e1-625.e5. [PMID: 27554308 DOI: 10.1016/j.wneu.2016.08.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The accurate histologic diagnosis of germ cell tumors in the pineal region is a keystone for determining the best treatment strategy and prognosis. This situation poses a challenge for the neuropathologist, considering the lack of a standarized procedure to obtain biopsy samples, which results in few and small specimens, which are not suitable for diagnosis. CASE DESCRIPTION We report a case in which a pineal region mixed germ cell tumor was accurately diagnosed by performing histologic mapping through a dual burr-hole endoscopic approach. The technical pitfalls and other considerations necessary for obtaining an accurate diagnosis in this tumor subgroup are specified. In addition, the histologic analysis regarding the sampling technique used is described. CONCLUSIONS The supraorbital frontal endoscopic approach enables the surgeon to perform histologic mapping of pineal region tumors, allowing standarization of the procedure used to obtain the specimens. This approach could result in a more accurate diagnosis, especially in mixed germ cell neoplasms.
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Abstract
Primary CNS tumors consist of a diverse group of neoplasms originating from various cell types in the CNS. Brain tumors are the most common solid malignancy in children under the age of 15 years and the second leading cause of cancer death after leukemia. The most common brain neoplasms in children differ consistently from those in older age groups. Pediatric brain tumors demonstrate distinct patterns of occurrence and biologic behavior according to sex, age, and race. This chapter highlights the imaging features of the most common tumors that affect the child's CNS (brain and spinal cord).
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Affiliation(s)
- Andre D Furtado
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Charles R Fitz
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Abstract
In this case report we present an adolescent girl who was referred to our radiology department for assessment with advanced magnetic resonance (MR) imaging on suspicion of low-grade quadrigeminal cistern neoplasm on 1.5 Tesla MR examination. We were able to evaluate detailed cerebellar anatomy more clearly, and detected that the lesion was compatible with ectopic cerebellar tissue (a very rare developmental variation) on submillimetric 3-dimensional (3D) images from a 3 Tesla MR unit which has a 32-channel head coil. Our findings were further supported by diffusion tensor imaging which clearly indicated that the lesion was a part of the cerebellum. Furthermore, MR spectroscopic metabolite ratios were in accordance with the characteristics of normal neuronal tissue. As far we know there is no published report that contains similar findings to those of our patient. In conclusion, cranial MR images, if possible in 3D format (with very small isotropic voxels) should be obtained for the precise diagnosis of the lesions located in this region; in addition, the differential diagnostic list should be well known and advanced imaging techniques should be used when necessary.
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Affiliation(s)
- Oktay Algin
- Radiology Department, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Evrim Ozmen
- Department of Radiology, Istanbul University, Hospital of Cerrahpasa Medical School, Istanbul, Turkey
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BÖHRNSEN FLORIAN, ENDERS CHRISTINA, LUDWIG HANSCHRISTOPH, BRÜCK WOLFGANG, FÜZESI LASZLO, GUTENBERG ANGELIKA. Common molecularcytogenetic alterations in tumors originating from the pineal region. Oncol Lett 2015; 10:1853-1857. [PMID: 26622764 PMCID: PMC4533695 DOI: 10.3892/ol.2015.3383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 05/07/2015] [Indexed: 12/31/2022] Open
Abstract
Tumors of the pineal region (PR) are rare and can be subdivided into four main histomorphological groups: Pineal-parenchymal tumors (PPT), germ cell tumors (GCT), glial tumors and miscellaneous tumors. The appropriate pathological classification and grading of these malignancies is essential for determining the clinical management and prognosis. However, an early diagnosis is often delayed due to unspecific clinical symptoms, and histological support is not always decisive to identify the diversity of tumors of the PR. The present study aimed to characterize 18 tumors of the PR using comparative genomic hybridization. All the tumors were primarily surgically resected without any previous irradiation or chemotherapy. In addition to chromosomal aberrations in PPT and different GCTs of the PR, the present study described, for the first time, the chromosomal changes in a few rare entities (solitary-fibrous and neuroendocrine tumors) of the PR. The tumors in the study, regardless of histology and World Health Organization grade, were characterized by frequent gains at 7, 9q, 12q, 16p, 17 and 22q, and losses at 13q. While the detection of chromosomal aberrations in these tumors appears not to be indicative enough of histological entities and their grade of malignancy, the present data may be of use to select genes of interest for higher resolution genomic analyses.
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Affiliation(s)
- FLORIAN BÖHRNSEN
- Clinic of Oral and Maxillofacial Surgery, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - CHRISTINA ENDERS
- Institute of Pathology, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - HANS-CHRISTOPH LUDWIG
- Department of Neurosurgery, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - WOLFGANG BRÜCK
- Institute of Neuropathology, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - LASZLO FÜZESI
- Institute of Pathology, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - ANGELIKA GUTENBERG
- Department of Neurosurgery, Georg-August University Göttingen, Göttingen D-37075, Germany
- Department of Neurosurgery, Johannes Gutenberg University, Mainz D-76726, Germany
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Gener MA, Conger AR, Van Gompel J, Ariai MS, Jentoft M, Meyer FB, Cardinal JS, Bonnin JM, Cohen-Gadol AA. Clinical, Pathological, and Surgical Outcomes for Adult Pineoblastomas. World Neurosurg 2015; 84:1816-24. [PMID: 26287970 DOI: 10.1016/j.wneu.2015.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Pineoblastomas are uncommon primitive neuroectodermal tumors that occur mostly in children; they are exceedingly rare in adults. Few published reports have compared the various aspects of these tumors between adults and children. METHODS The authors report a series of 12 pineoblastomas in adults from 2 institutions over 24 years. The clinical, radiologic, and pathologic features and clinical outcomes were compared with previously reported cases in children and adults. RESULTS Patient age ranged from 24 to 81 years, and all but 1 patient exhibited symptoms of obstructive hydrocephalus. Three patients underwent gross total resection, and subtotal resection was performed in 3 patients. Diagnostic biopsy specimens were obtained in an additional 6 patients. Pathologically, the tumors had the classical morphologic and immunohistochemical features of pineoblastomas. Postoperatively, 10 patients received radiotherapy, and 5 patients received chemotherapy. Compared with previously reported cases, several differences were noted in clinical outcomes. Of the 12 patients, only 5 (42%) died of their disease (average length of survival, 118 months); 5 patients (42%) are alive with no evidence of disease (average length of follow-up, 92 months). One patient died of unrelated causes, and one was lost to follow-up. Patients with subtotal resections or diagnostic biopsies did not suffer a worse prognosis. Of the 9 patients with biopsy or subtotal resection, 4 are alive, 4 died of their disease, and 1 died of an unrelated hemorrhagic cerebral infarction. CONCLUSIONS Although this series is small, the data suggest that pineoblastomas in adults have a less aggressive clinical course than in children.
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Affiliation(s)
- Melissa A Gener
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew R Conger
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jamie Van Gompel
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammad S Ariai
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Jentoft
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Fredric B Meyer
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy S Cardinal
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - José M Bonnin
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA; Indiana University Simon Cancer Center, Indianapolis, Indiana, USA.
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Diffusion-weighted imaging and the apparent diffusion coefficient on 3T MR imaging in the differentiation of craniopharyngiomas and germ cell tumors. Neurosurg Rev 2015; 39:207-13; discussion 213. [PMID: 26280640 DOI: 10.1007/s10143-015-0660-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 04/05/2015] [Accepted: 06/27/2015] [Indexed: 10/23/2022]
Abstract
The apparent diffusion coefficient (ADC) on diffusion-weighted imaging (DWI) plays an important role in diagnosing intracranial tumors and predicting the histopathological grade of the tumor. However, the differences in the ADC values between craniopharyngiomas and germ cell tumors (GCTs) have not been clarified. We therefore evaluated the DWI and ADC values at b = 1000 and b = 4000 s/mm(2) on 3T magnetic resonance (MR) imaging and assessed the possibility of differentiating between craniopharyngiomas and GCTs. We retrospectively reviewed 19 patients with craniopharyngioma and 24 patients with GCT who underwent surgery and received a histopathological diagnosis. Thirty-four patients underwent DWI with b = 1000 and b = 4000 s/mm(2) and nine patients underwent periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) DWI with b = 1000 s/mm(2). The ADC was determined by manually placing regions of interests (ROIs) in the respective tumor regions on the ADC maps and is expressed as the minimum (ADC(MIN)), mean (ADC(MEAN)), and maximum (ADC(MAX)) absolute values. The craniopharyngiomas showed lower intensity on DWI at b = 1000 and b = 4000 s/mm(2) than the GCTs. Furthermore, the craniopharyngiomas demonstrated significantly high ADC values (ADC(MIN), ADC(MEAN), and ADC(MAX)) in comparison with the GCTs on DWI at b = 1000 and b = 4000 s/mm(2). The logistic discriminant analysis clarified the advantage of ADC(MIN) at b = 4000 s/mm(2) in differentiating between craniopharyngiomas and GCTs compared with the other ADC values. DWI and the ADC values may help clinicians to differentiate between craniopharyngiomas and GCTs. The ADC(MIN) at b = 4000 s/mm(2) is particularly useful for differentiation.
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Deiana G, Mottolese C, Hermier M, Louis-Tisserand G, Berthezene Y. Imagery of pineal tumors. Neurochirurgie 2015; 61:113-22. [DOI: 10.1016/j.neuchi.2014.10.111] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 10/13/2014] [Accepted: 10/15/2014] [Indexed: 12/26/2022]
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Choudhri AF, Whitehead MT, Siddiqui A, Klimo P, Boop FA. Diffusion characteristics of pediatric pineal tumors. Neuroradiol J 2015; 28:209-16. [PMID: 25963154 PMCID: PMC4757159 DOI: 10.1177/1971400915581741] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Diffusion weighted imaging (DWI) has been shown to be helpful in characterizing tumor cellularity, and predicting histology. Several works have evaluated this technique for pineal tumors; however studies to date have not focused on pediatric pineal tumors. OBJECTIVE We evaluated the diffusion characteristics of pediatric pineal tumors to confirm if patterns seen in studies using mixed pediatric and adult populations remain valid. MATERIALS AND METHODS This retrospective study was performed after Institutional Review Board approval. We retrospectively evaluated all patients 18 years of age and younger with pineal tumors from a single institution where preoperative diffusion weighted imaging as well as histologic characterization was available. RESULTS Twenty patients (13 male, 7 female) with pineal tumors were identified: seven with pineoblastoma, four with Primitive Neuroectodermal Tumor (PNET), two with other pineal tumors, and seven with germ cell tumors including two germinomas, three teratomas, and one mixed germinoma-teratoma. The mean apparent diffusion coefficient (ADC) values in pineoblastoma (544 ± 65 × 10⁻⁶ mm²/s) and pineoblastoma/PNET (595 ± 144 × 10⁻⁶ mm²/s) was lower than that of the germ cell tumors (1284 ± 334 × 10⁻⁶ mm²/s; p < 0.0001 vs pineoblastoma). One highly cellular germinoma had an ADC value of 694 × 10⁻⁶ mm²/s. CONCLUSION ADC values can aid in differentiation of pineoblastoma/PNET from germ cell tumors in a population of children with pineal masses.
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Affiliation(s)
- Asim F Choudhri
- Department of Radiology, University of Tennessee Health Science Center, USA Department of Neurosurgery, University of Tennessee Health Science Center, USA Department of Ophthalmology, University of Tennessee Health Science Center, USA Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, USA
| | - Matthew T Whitehead
- Department of Radiology, University of Tennessee Health Science Center, USA Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, USA Department of Radiology, Children's National Medical Center, USA
| | - Adeel Siddiqui
- Department of Radiology, University of Tennessee Health Science Center, USA Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, USA Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, USA Semmes-Murphey Neurologic and Spine Institute, USA Division of Neurosurgery, St Jude Children's Hospital, USA
| | - Frederick A Boop
- Department of Neurosurgery, University of Tennessee Health Science Center, USA Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, USA Semmes-Murphey Neurologic and Spine Institute, USA Division of Neurosurgery, St Jude Children's Hospital, USA
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Reddy MP, Saad AF, Doughty KE, Armstrong D, Melguizo-Gavilanes I, Cheek BS, Opatowsky MJ. Intracranial germinoma. Proc AMIA Symp 2015; 28:43-5. [PMID: 25552796 PMCID: PMC4264708 DOI: 10.1080/08998280.2015.11929183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Pineal region tumors make up less than 1% of all intracranial neoplasms, with the majority being of germ cell origin. We describe the diagnostic evaluation and treatment of a patient presenting with neurological deficits who was found to have a germinoma of the pineal gland.
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Affiliation(s)
- Manoj P Reddy
- Texas A&M College of Medicine (Reddy) and the Departments of Diagnostic Radiology (Saad, Opatowsky), Neurosurgery (Doughty), Pathology (Armstrong), Neurooncology (Melguizo-Gavilanes), and Radiation Oncology (Cheek), Baylor University Medical Center at Dallas
| | - Amin F Saad
- Texas A&M College of Medicine (Reddy) and the Departments of Diagnostic Radiology (Saad, Opatowsky), Neurosurgery (Doughty), Pathology (Armstrong), Neurooncology (Melguizo-Gavilanes), and Radiation Oncology (Cheek), Baylor University Medical Center at Dallas
| | - Kyle E Doughty
- Texas A&M College of Medicine (Reddy) and the Departments of Diagnostic Radiology (Saad, Opatowsky), Neurosurgery (Doughty), Pathology (Armstrong), Neurooncology (Melguizo-Gavilanes), and Radiation Oncology (Cheek), Baylor University Medical Center at Dallas
| | - Danielle Armstrong
- Texas A&M College of Medicine (Reddy) and the Departments of Diagnostic Radiology (Saad, Opatowsky), Neurosurgery (Doughty), Pathology (Armstrong), Neurooncology (Melguizo-Gavilanes), and Radiation Oncology (Cheek), Baylor University Medical Center at Dallas
| | - Isaac Melguizo-Gavilanes
- Texas A&M College of Medicine (Reddy) and the Departments of Diagnostic Radiology (Saad, Opatowsky), Neurosurgery (Doughty), Pathology (Armstrong), Neurooncology (Melguizo-Gavilanes), and Radiation Oncology (Cheek), Baylor University Medical Center at Dallas
| | - Brennen S Cheek
- Texas A&M College of Medicine (Reddy) and the Departments of Diagnostic Radiology (Saad, Opatowsky), Neurosurgery (Doughty), Pathology (Armstrong), Neurooncology (Melguizo-Gavilanes), and Radiation Oncology (Cheek), Baylor University Medical Center at Dallas
| | - Michael J Opatowsky
- Texas A&M College of Medicine (Reddy) and the Departments of Diagnostic Radiology (Saad, Opatowsky), Neurosurgery (Doughty), Pathology (Armstrong), Neurooncology (Melguizo-Gavilanes), and Radiation Oncology (Cheek), Baylor University Medical Center at Dallas
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