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Journal of Neuro-Oncology

, Volume 101, Issue 2, pp 301–306 | Cite as

Pineal parenchymal tumor of intermediate differentiation with papillary features: a continuum of primary pineal tumors?

  • Jessica N. Cohan
  • Jennifer A. Moliterno
  • Christina L. Mok
  • Ehud Lavi
  • John A. BoockvarEmail author
Case Report

Abstract

Pineal parenchymal tumors comprise a rare group of primary neoplasms of the pineal gland. We describe a case involving a 29-year-old woman who presented with signs and symptoms of hydrocephalus secondary to a pineal region tumor obstructing the third ventricle. Surgical resection was performed and pathological analysis revealed a novel diagnosis consistent with a pineal parenchymal tumor of intermediate differentiation (PPTID) with transition to a papillary tumor of the pineal region (PTPR). To our knowledge, this particular pineal region tumor pathology has not yet been reported in the literature and highlights the continuum with which primary pineal tumors exist. We provide a review of the existing literature on pineal region tumors, specifically PTPR and PPTID, and offer insight into the management of these rare neoplasms.

Keywords

Pineal parenchymal tumor Obstructive hydrocephalus Papillary tumor of the pineal region Pineal parenchymal tumor of intermediate differentiation 

Abbreviations

PPTID

Pineal parenchymal tumor of intermediate differentiation

PTPR

Papillary tumor of the pineal region

PPT

Pineal parenchymal tumor

CNS

Central nervous system

WHO

World Health Organization

PC

Pineocytoma

PB

Pineoblastoma

MRI

Magnetic resonance imaging

ETV

Endoscopic third ventriculostomy

PLAP

Placental alkaline phosphatase

CK

Cytokeratin

AFP

Alpha fetoprotein

GFAP

Glial fibrillary acidic protein

NF

Neurofilament

HCG

Human chorionic gonadotropin

EMA

Epithelial membrane antigen

NSE

Neuron specific enolase

References

  1. 1.
    Schild SE, Scheithauer BW, Schomberg PJ, Hook CC, Kelly PJ, Frick L, Robinow JS, Buskirk SJ (1993) Pineal parenchymal tumors: clinical, pathologic, and therapeutic aspects. Cancer 72:870–880CrossRefPubMedGoogle Scholar
  2. 2.
    Konovalov AN, Pitskhelauri DI (2003) Principles of treatment of the pineal region tumors. Surg Neurol 59:250–268CrossRefPubMedGoogle Scholar
  3. 3.
    Louis D, Ohgaki H, Wiestler O, Cavenee W, Burger P, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114:97–109CrossRefPubMedGoogle Scholar
  4. 4.
    Ang L, Taylor A, Bergin D, Kaufman J (1990) An immunohistochemical study of papillary tumors in the central nervous system. Cancer 65:2712–2719CrossRefPubMedGoogle Scholar
  5. 5.
    Vaquero J, Coca S, Martinez R, Escandon J (1990) Papillary pineocytoma: case report. J Neurosurg 73:135–137CrossRefPubMedGoogle Scholar
  6. 6.
    Hirato J, Nakazato Y (2001) Pathology of pineal region tumors. J Neurooncol 54:239–249CrossRefPubMedGoogle Scholar
  7. 7.
    Howard BM, Hofstetter C, Wagner PL, Muskin ET, Lavi E, Boockvar JA (2009) Transformation of a low-grade pineal parenchymal tumor to secondary pineoblastoma. Neuropathol Appl Neurobiol 35:214–217CrossRefPubMedGoogle Scholar
  8. 8.
    Jouvet A, Fauchon F, Liberski P, Saint-Pierre G, Didier-Bazes M, Heitzmann A, Delisle MB, Biassette HA, Vincent S, Mikol J, Streichenberger N, Ahboucha S, Brisson C, Belin MF, Fevre-Montange M (2003) Papillary tumor of the pineal region. Am J Surg Pathol 27:505–512CrossRefPubMedGoogle Scholar
  9. 9.
    Trojanowski JQ, Tascos NA, Rorke LB (1982) Malignant pineocytoma with prominent papillary features. Cancer 50:1789–1793CrossRefPubMedGoogle Scholar
  10. 10.
    Jouvet A, Fèvre-Montange M, Besançon R, Derrington E, Saint-Pierre G, Belin MF, Pialat J, Lapras C (1994) Structural and ultrastructural characteristics of human pineal gland, and pineal parenchymal tumors. Acta Neuropathol 88(4):334–348CrossRefPubMedGoogle Scholar
  11. 11.
    Fevre-Montange M, Hasselblatt M, Figarella-Branger D, Chauveinc L, Champier J, Saint-Pierre G, Taillandier L, Coulon A, Paulus W, Fauchon F, Jouvet A (2006) Prognosis and histopathologic features in papillary tumors of the pineal region: a retrospective multicenter study of 31 cases. J Neuropathol Exp Neurol 65:1004–1011CrossRefPubMedGoogle Scholar
  12. 12.
    Sato K, Kubota T (2009) Pathology of pineal parenchymal tumors. Prog Neurol Surg 23:12–25CrossRefPubMedGoogle Scholar
  13. 13.
    Hasselblatt M, Blümcke I, Jeibmann A, Rickert CH, Jouvet A, van de Nes JA, Kuchelmeister K, Brunn A, Fevre-Montange M, Paulus W (2006) Immunohistochemical profile and chromosomal imbalances in papillary tumours of the pineal region. Neuropathol Appl Neurobiol 32(3):278–283CrossRefPubMedGoogle Scholar
  14. 14.
    Jouvet A, Saint-Pierre G, Fauchon F, Privat K, Bouffet E, Ruchoux MM, Chauveinc L, Fevre-Montange M (2000) Pineal parenchymal tumors: a correlation of histological features with prognosis in 66 cases. Brain Pathol 10:49–60CrossRefPubMedGoogle Scholar
  15. 15.
    Fèvre-Montange M, Grand S, Champier J, Hoffmann D, Pasquier B, Jouvet A (2008) Bcl-2 expression in a papillary tumor of the pineal region. Neuropathology 28(6):660–663PubMedGoogle Scholar
  16. 16.
    Roncaroli F, Scheithauer BW (2007) Papillary tumor of the pineal region and spindle cell oncocytoma of the pituitary: new tumor entities in the 2007 WHO classification. Brain Pathol 17:314–318CrossRefPubMedGoogle Scholar
  17. 17.
    Dagnew E, Langford LA, Lang FF, DeMonte F (2007) Papillary tumors of the pineal region: case report. Neurosurgery 60:953–955CrossRefGoogle Scholar
  18. 18.
    Blakeley JO, Grossman SA (2006) Management of pineal region tumors. Curr Treat Options Oncol 7:505–516CrossRefPubMedGoogle Scholar
  19. 19.
    Fauchon F, Jouvet A, Paquis P, Saint-Pierre G, Mottolese C, Ben Hassel M, Chauveinc L, Sichez JP, Philippon J, Schlienger M, Bouffet E (2000) Parenchymal pineal tumors: a clinicopathological study of 76 cases. Int J Radiat Oncol Biol Phys 46:959–968CrossRefPubMedGoogle Scholar
  20. 20.
    Lutterbach J, Fauchon F, Schild SE, Chang SM, Pagenstecher A, Volk B, Ostertag C, Momm F, Jouvet A (2002) Malignant pineal parenchymal tumors in adult patients: patterns of care and prognostic factors. Neurosurgery 51:44–56CrossRefPubMedGoogle Scholar
  21. 21.
    Pusztaszeri M, Pica A, Janzer R (2006) Pineal parenchymal tumors of intermediate differentiation in adults: case report and literature review. Neuropathology 26:153–157CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Jessica N. Cohan
    • 1
  • Jennifer A. Moliterno
    • 2
  • Christina L. Mok
    • 1
  • Ehud Lavi
    • 3
  • John A. Boockvar
    • 1
    Email author
  1. 1.Department of Neurological Surgery, Weill Cornell Brain Tumor CenterWeill Medical College of Cornell University, New York Presbyterian HospitalNew YorkUSA
  2. 2.Department of NeurosurgeryYale University School of Medicine, Yale-New Haven HospitalNew HavenUSA
  3. 3.Department of PathologyWeill Cornell Medical College of Cornell University, New York Presbyterian HospitalNew YorkUSA

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