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Brain Tumor Pathology

, 25:85 | Cite as

Papillary tumor of the pineal region: a case report

  • Tomoo Inoue
  • Toshihiro KumabeEmail author
  • Masayuki Kanamori
  • Yukihiko Sonoda
  • Mika Watanabe
  • Teiji Tominaga
Case Report

Abstract

We report a case of papillary tumor of the pineal region (PTPR) and describe the morphological, immunohistochemical, and neuroimaging findings. A 43-year-old man presented with signs of increased intracranial pressure and upward gaze palsy. Magnetic resonance (MR) imaging demonstrated a heterogeneously enhanced mass in the pineal region and obstructive hydrocephalus. Proton MR spectroscopy revealed increased choline and decreased N-acetyl aspartate peaks with a slightly increased lactate peak. Minimum apparent diffusion coefficient value was 0.60 × 10−3 mm2/s. Positron emission tomography showed significantly increased [18F]fluorodeoxyglucose uptake at the site of the lesion. He underwent total resection of the pineal region mass, resulting in resolution of the symptoms. The tumor consisted of columnar and cuboidal cells, with papillary growth pattern. Immunohistochemical staining showed positive reaction for neuron-specific enolase, S-100 protein, and vimentin. Ki-67 labeling index (LI) was 13.1%. These features were consistent with PTPR. Postoperatively, the patient received radiochemotherapy, and maintenance chemotherapy at our outpatient clinic, and was doing well without tumor recurrence 1 year after the surgery. Although the morphological features agree with those in the original description of the PTPR, the Ki-67 LI and radiologic findings suggest the malignant nature and the necessity for adjuvant therapy.

Key words

Papillary tumor of the pineal region Magnetic resonance spectroscopy Apparent diffusion coefficient [18F]Fluorodeoxyglucose positron emission tomography Ki-67 labeling index 

References

  1. 1.
    Ang LC, Taylor AR, Bergin D, et al (1990) An immunohistochemical study of papillary tumors in the central nervous system. Cancer (Phila) 65:2712–2719CrossRefGoogle Scholar
  2. 2.
    Louis DN, Ohgaki H, Wiestler OD, et al (2007) The 2007 WHO Classification of Tumours of the Central Nervous System. Acta Neuropathol (Berl) 114:97–109CrossRefGoogle Scholar
  3. 3.
    Jouvet A, Nakazato Y, Scheithauer BW, et al (2007) Papillary tumour of the pineal region. In: Louis DN, Ohgaki H, Wiestler OD, et al (eds) World Health Organization classification of tumours of the nervous system. IARC, Lyon, pp 128–129Google Scholar
  4. 4.
    Boco T, Aalaei S, Musacchio M, et al (2008) Papillary tumor of the pineal region. Neuropathology 28:87–92PubMedCrossRefGoogle Scholar
  5. 5.
    Chang AH, Fuller GN, Debnam JM, et al (2008) MR imaging of papillary tumor of the pineal region. AJNR Am J Neuroradiol 29:187–189PubMedCrossRefGoogle Scholar
  6. 6.
    Dagnew E, Langford LA, Lang FF, et al (2007) Papillary tumors of the pineal region: case report. Neurosurgery 60:953–955CrossRefGoogle Scholar
  7. 7.
    Hasselblatt M, Blumcke I, Jeibmann A, et al (2006) Immunohistochemical profile and chromosomal imbalances in papillary tumours of the pineal region. Neuropathol Appl Neurobiol 32: 278–283PubMedCrossRefGoogle Scholar
  8. 8.
    Jouvet A, Fauchon F, Liberski P, et al (2003) Papillary tumor of the pineal region. Am J Surg Pathol 27:505–512PubMedCrossRefGoogle Scholar
  9. 9.
    Kawahara I, Tokunaga Y, Yagi N, et al (2007) Papillary tumor of the pineal region. Neurol Med Chir (Tokyo) 47:568–571CrossRefGoogle Scholar
  10. 10.
    Kern M, Robbins P, Lee G, et al (2006) Papillary tumor of the pineal region-a new pathological entity. Clin Neuropathol 25: 185–192PubMedGoogle Scholar
  11. 11.
    Shibahara J, Todo T, Morita A, et al (2004) Papillary neuroepithelial tumor of the pineal region. A case report. Acta Neuropathol (Berl) 108:337–340CrossRefGoogle Scholar
  12. 12.
    Fevre-Montange M, Hasselblatt M, Figarella-Branger D, et al (2006) Prognosis and histopathologic features in papillary tumors of the pineal region: a retrospective multicenter study of 31 cases. J Neuropathol Exp Neurol 65:1004–1111PubMedGoogle Scholar
  13. 13.
    Higano S, Yun X, Kumabe T, et al (2006) Malignant astrocytic tumors: clinical importance of apparent diffusion coefficient in prediction of grade and prognosis. Radiology 241:839–846PubMedCrossRefGoogle Scholar
  14. 14.
    Fevre-Montange M, Champier J, Szathmari A, et al (2006) Microarray analysis reveals differential gene expression patterns in tumors of the pineal region. J Neuropathol Exp Neurol 65: 675–684PubMedCrossRefGoogle Scholar
  15. 15.
    Leonardt H. Ependym und circumventriculäre Organe (1980) In: Oksche A, Vollrath L (eds) Neuroglia I: Handbuch der mikroskopischen Anatomie des Menschen. Springer, Berlin, pp 177–665Google Scholar
  16. 16.
    Meiniel A (2007) The secretory ependymal cells of the subcommissural organ: which role in hydrocephalus? Int J Biochem Cell Biol 39:463–468PubMedCrossRefGoogle Scholar
  17. 17.
    Perez-Figares JM, Jimenez AJ, Rodriguez EM (2001) Subcommissural organ, cerebrospinal fluid circulation, and hydrocephalus. Microsc Res Tech 52:591–607PubMedCrossRefGoogle Scholar
  18. 18.
    Rodriguez EM, Oksche A, Montecinos H (2001) Human subcommissural organ, with particular emphasis on its secretory activity during the fetal life. Microsc Res Tech 52:573–590PubMedCrossRefGoogle Scholar

Copyright information

© Japan Soceity of BrainTumor Pathology 2008

Authors and Affiliations

  • Tomoo Inoue
    • 1
  • Toshihiro Kumabe
    • 1
    Email author
  • Masayuki Kanamori
    • 1
  • Yukihiko Sonoda
    • 1
  • Mika Watanabe
    • 2
  • Teiji Tominaga
    • 1
  1. 1.Department of NeurosurgeryTohoku University Graduate School of MedicineSendaiJapan
  2. 2.Department of PathologyTohoku University HospitalSendaiJapan

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