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Neurology India 2019Pineal gland tumors range from the well-differentiated "pineocytoma" [World Health Organization (WHO) grade I], which have a very good prognosis, to the aggressive and...
BACKGROUND
Pineal gland tumors range from the well-differentiated "pineocytoma" [World Health Organization (WHO) grade I], which have a very good prognosis, to the aggressive and poorly differentiated "pineoblastoma" (WHO grade IV) with "pineal parenchymal tumor of intermediate differentiation" (PPTID; WHO grades II and III) occupying intermediary differentiation and prognosis. Papillary tumor of the pineal region (PTPR; WHO grades II and III) is a distinct entity with propensity for recurrence and spinal dissemination. However, the diagnostic criteria to differentiate these entities, especially between WHO grades II and III of both PPTID and PTPR, remain nebulous.
OBJECTIVE
To evaluate the relative frequency of the individual entities and histomorphological (including the proliferation indices) features across the spectrum of pineal parenchymal tumors (PPTs) [including PTPRs] along their course.
DESIGN
All cases of PPTs were retrieved, reviewed, and graded based on the histological criteria defined in the literature.
RESULTS
PPTID, more commonly seen in young adults, was the most common subtype of PPT. This was followed by pineoblastoma which was more commonly seen in children. Clinical progression was seen in both grades II and III of PPTID; however, it was more commonly seen in cases with a MIB1 labeling index of >10%. PTPRs (both grades II and III) showed an aggressive histological transformation and also intraparenchymal metastasis.
CONCLUSION
PPTIDs are the most common adult primary PPTs and have the potential to progress and disseminate in both grades II and III. Both grades of PTPRs have a metastatic potential. These findings suggest the need for postoperative adjuvant therapy in both grades of PPTID and PTPR.
Topics: Brain Neoplasms; Child; Combined Modality Therapy; Female; Humans; Male; Neoplasm Recurrence, Local; Pineal Gland; Pinealoma; Prognosis; Young Adult
PubMed: 31085866
DOI: 10.4103/0028-3886.258045 -
The Malaysian Journal of Pathology Apr 2019Intratumoral calcification is a feature that is more often observed in pineal parenchymal tumour than germinoma. We describe a 13-year-old male with pineal region...
INTRODUCTION
Intratumoral calcification is a feature that is more often observed in pineal parenchymal tumour than germinoma. We describe a 13-year-old male with pineal region germinoma demonstrating extensive intratumoral calcification.
CASE REPORT
He presented with worsening headache that was associated with fatigue, nausea and vomiting. Radiologic examination revealed a multilobular mass in the pineal region with internal calcifications. Biopsy showed a pure germinoma with unusually extensive calcification.
DISCUSSION
Although a diagnosis may be suggested with a careful evaluation of imaging, there is no pathognomonic pattern. Thus, histologic verification is necessary for most pineal region masses.
Topics: Adolescent; Calcinosis; Germinoma; Humans; Male; Pinealoma
PubMed: 31025642
DOI: No ID Found -
Ochsner Journal 2019The pineal gland, a small, pinecone-shaped organ deep within the brain, is responsible for producing melatonin. The gland consists of pineal parenchymal cells and glial... (Review)
Review
The pineal gland, a small, pinecone-shaped organ deep within the brain, is responsible for producing melatonin. The gland consists of pineal parenchymal cells and glial cells that can form neoplasms. Pineal region neoplasms can also arise from germ cells and adjacent structures. This review focuses on detection of serum and cerebrospinal fluid (CSF) biomarkers of germ cell tumors and pineal parenchymal cell tumors, as these types comprise most neoplasms specific to the pineal region. For this review, we searched PubMed using the following keywords: biomarkers, germ cell tumor, germinoma, melatonin, pineal, pineal gland, pineal neoplasm, pinealoma, pineal parenchymal cell tumor, pineal region, and pineal tumor. We limited our search to full-text English articles and identified other relevant sources from the reference lists of identified articles. Serum and CSF biomarker assays have a role in cases of suspected pineal germ cell or parenchymal neoplasms. Biomarkers including alpha-fetoprotein, beta-human chorionic gonadotropin, and placental alkaline phosphatase inform diagnosis and treatment and are important for monitoring germ cell tumor response to treatment. No biomarkers are currently available that inform diagnosis or treatment of pineal parenchymal tumors, although melatonin assays may have a role in monitoring response to treatment. Serum and CSF biomarkers in conjunction with clinical and radiographic evidence of a pineal region mass can inform the decision whether to undertake stereotactic biopsy or surgical excision or whether to proceed straight to medical treatment.
PubMed: 30983898
DOI: 10.31486/toj.18.0110 -
Acta Neuropathologica May 2019
Recurrent KBTBD4 small in-frame insertions and absence of DROSHA deletion or DICER1 mutation differentiate pineal parenchymal tumor of intermediate differentiation (PPTID) from pineoblastoma.
Topics: Adolescent; Adult; Biomarkers, Tumor; Brain; Brain Neoplasms; Carrier Proteins; Child; Cohort Studies; DEAD-box RNA Helicases; Diagnosis, Differential; Female; Humans; Infant; Male; Middle Aged; Mutation; Pineal Gland; Pinealoma; Ribonuclease III
PubMed: 30877433
DOI: 10.1007/s00401-019-01990-5 -
Unedited microneurosurgery of a high-grade pineal parenchymal tumor of intermediate differentiation.Surgical Neurology International 2018WHO Grade II-III pineal parenchymal tumors of intermediate differentiation (PPTIDs) were included in the 2007 World Health Organization Classification of Central Nervous...
BACKGROUND
WHO Grade II-III pineal parenchymal tumors of intermediate differentiation (PPTIDs) were included in the 2007 World Health Organization Classification of Central Nervous System Tumors as pineal parenchymal tumors between pineocytomas and pineoblastomas. PPTIDs comprise more than 20-60% of all pineal parenchymal tumors (PPT) s and are characterized by moderately high cellularity, mild-to-moderate nuclear atypia, and low-to-moderate mitotic activity. Moreover, PPTID includes transitional cases in which pineocytomatous and pineoblastoma features are associated. Synaptophysin and neuron-specific enolase are usually positive, with variable reactivity to neurofilament protein, chromogranin A, retinal S-antigen, and S-100 protein. PPTID Grades II and III can be distinguished on the basis of mitotic activity (higher in high-grade PPTID) and neurofilament protein immunoreactivity (higher in low-grade PPTID). Herein, we present the microsurgical management of a histologically confirmed high-grade PPTID.
CASE DESCRIPTION
A patient with high grade PPTID underwent sitting praying position and right paramedian supracerebellar infratentorial approach. The lesion was identified after lateral opening of the quadrigeminal cistern, followed by removal of its cystic component. Tissue samples were obtained under high microscopic magnification, and internal debulking of the tumor was performed with ring microforceps and bipolar forceps in the right hand and a thumb-regulated suction tube in the left hand. Continuous water irrigation provided us a clean surgical field and the recognition of small bleeding vessels. Moreover, water dissection technique was applied to recognize the cleavage plane of the tumor. Bipolar coagulation forceps were used to shrink the tumor and remove it by piecemeal reduction aiming to identify the anterior and lateral limits of the lesion. The poorly differentiated borders between the tumor and the surrounding parenchyma were determined under microscopic vision. Small vessels feeding the tumor were coagulated and cut. The most critical surgical stage was related with removal of some tumor remnants attached to the internal cerebral veins. A meticulous and skillful dissection was essential aiming to preserve these vascular structures. The final steps included meticulous hemostasis with electrocoagulation, Tachosil, and Surgicel. The postoperative course was uneventful. The patient underwent adjuvant radiotherapy and currently is alive, free of tumor recurrence 4 years after surgery.
CONCLUSION
This unedited video offers all detailed aspects that are, as the senior author JH considers, essential for a neurosurgeon when performing an efficient and safe surgery for a high-grade PPTID.
VIDEOLINK
http://surgicalneurologyint.com/videogallery/pineal-tumor-2.
PubMed: 30603232
DOI: 10.4103/sni.sni_353_18 -
Ugeskrift For Laeger Nov 2018Parinaud syndrome (PS) can manifest in a pineal tumour. Major components of PS include restriction of gazing upwards, light-near dissociation and convergence retraction...
Parinaud syndrome (PS) can manifest in a pineal tumour. Major components of PS include restriction of gazing upwards, light-near dissociation and convergence retraction nystagmus. A 14-year-old boy presented with diplopia and restricted ability to gaze upwards. The objective examination revealed signs, which were compatible with the major manifestations of PS. A magnetic resonance scan (MRI) of cerebrum indicated pinealoma, and a pathological examination identified the lesion as a germ cell carcinoma. The patient received chemotherapy and stereotactic radiosurgery. The ophthalmic symptoms improved, and a follow-up MRI demonstrated complete regression of the tumour.
Topics: Adolescent; Brain Neoplasms; Humans; Magnetic Resonance Imaging; Male; Ocular Motility Disorders; Pineal Gland; Pinealoma; Syndrome
PubMed: 30417817
DOI: No ID Found -
Ugeskrift For Laeger Oct 2018Parinaud syndrome (PS) can manifest in a pineal tumour. Major components of PS include restriction of gazing upwards, light-near dissociation and convergence retraction...
Parinaud syndrome (PS) can manifest in a pineal tumour. Major components of PS include restriction of gazing upwards, light-near dissociation and convergence retraction nystagmus. A 14-year-old boy presented with diplopia and restricted ability to gaze upwards. The objective examination revealed signs, which were compatible with the major manifestations of PS. A magnetic resonance scan (MRI) of cerebrum indicated pinealoma, and a pathological examination identified the lesion as a germ cell carcinoma. The patient received chemotherapy and stereotactic radiosurgery. The ophthalmic symptoms improved, and a follow-up MRI demonstrated complete regression of the tumour.
Topics: Adolescent; Brain Neoplasms; Humans; Magnetic Resonance Imaging; Male; Ocular Motility Disorders; Pineal Gland; Pinealoma
PubMed: 30375957
DOI: No ID Found -
Neuro-oncology Jan 2019
Topics: Adult; Antineoplastic Agents; Brain Neoplasms; Carcinoma, Papillary; Everolimus; Humans; Male; Neoplasm Recurrence, Local; Pineal Gland; Pinealoma; Prognosis; TOR Serine-Threonine Kinases
PubMed: 30295836
DOI: 10.1093/neuonc/noy153 -
Journal of Cancer Research and... Sep 2018Ectopic extrarenal renin-producing tumor is a rare disease with approximately 30 case reports in English literature. We herein present the first case of renin-producing...
Ectopic extrarenal renin-producing tumor is a rare disease with approximately 30 case reports in English literature. We herein present the first case of renin-producing germ cell tumors in the pineal apparatus and mediastinum. A 26-year-old man who had undergone craniotomy for the treatment of pineal tumor was found to have hypertension at a regular visit postoperatively. Laboratory findings revealed high plasma levels of renin activity and that of aldosterone concentration. Chest computed tomography demonstrated a large tumor in the mediastinum. The pathological findings revealed the mediastinal germ cell tumor positive for renin. The present case suggests that for young patients presenting with hypertension with a mediastinal tumor, the possibility of a renin-producing tumor should be considered.
Topics: Adult; Aldosterone; Craniotomy; Humans; Hypertension; Male; Mediastinal Neoplasms; Neoplasms, Germ Cell and Embryonal; Pinealoma; Renin; Tomography, X-Ray Computed
PubMed: 30249910
DOI: 10.4103/0973-1482.180682 -
BMJ Case Reports Sep 2018
Topics: Brain Neoplasms; Child, Preschool; DiGeorge Syndrome; Fatal Outcome; Female; Humans; Magnetic Resonance Imaging; Pineal Gland; Pinealoma
PubMed: 30217803
DOI: 10.1136/bcr-2018-226434