Abstract
Various histological types of tumors arise in the pineal region. The most common tumors are pineal parenchymal tumors and germ cell tumors. Pineal parenchymal tumors are divided into pineocytoma, pineal parenchymal tumor with intermediate differentiation and pineoblastoma. Pineocytomas are well-differentiated tumors and retain the morphological and immunohistochemical features of pineal parenchymal cells. Lobular architectures and pineocytomatous rosettes are also typical features. In contrast, pineoblastomas are embryonal tumors resembling primitive neuroectodermal tumors (PNET). However, pineoblastomas are distinct from PNET in other sites due to their exhibiting photosensory differentiation including Flexner–Wintersteiner rosettes and fleurettes. Although pineal cysts are tumor-like lesions, and not true neoplasms, they are occasionally difficult to distinguish from pineocytoma and astrocytoma. From the therapeutic aspect, a precise differential diagnosis is critical.
The pineal region is the most common site of the brain in which germ cell tumors occur. Germinoma, teratoma, embryonal carcinoma, yolk sac tumor and choriocarcinoma are encountered, and the latter three types of tumors usually constitute elements of mixed germ cell tumors. The morphological and immunohistochemical features of intracranial germ cell tumors are very similar to those of gonadal germ cell tumors, although there are some differences in germinoma. Pineal germinoma may exhibit carcinomatous differentiation.
Other types of tumors are occasionally observed, including fibrillary and pilocytic astrocytoma, glioblastoma, ependymoma, melanoma, meningioma and so on. Metastatic pineal tumors are also rare. The most common site of origin for pineal metastasis is the lung.
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References
Lantos PL, VandenBerg SR, Kleihues P: Tumours of the nervous system. In: Graham DI, Lantos PL (eds) Greenfield's neuropathology. 6th edn, Vol 2. Arnold, London, 1997, pp 677–682
Brain Tumor Registry of Japan. vol 9 1969-1990, The Committee of Brain Tumor Registry of Japan, Tokyo, 1996
Mena H, Nakazato Y, Jouvet A, Scheithauer BW: Pineal parenchymal tumours. In: Kleihues P, Cavenee WK (eds) Pathology and Genetics of Tumours of the Nervous System. IARC Press, Lyon, 2000, pp 115–121
Broit A, Blackwood W, Mair WG: The separation of pineocytoma from pineoblastoma. Cancer 45: 1408–1418, 1980
Herrick MK, Rubinstein LJ: The cytological differentiating potential of pineal parenchymal neoplasms (true pinealomas). A clinicopathological study of 28 tumours. Brain 102: 289–320, 1979.
Trojanowski JQ, Tascos NA, Rorke LB: Malignant pineocytoma with prominent papillary features. Cancer 50: 1789–1793, 1982
Jouvet A, Fevre-Montange M, Besancon R, Derrington E, Saint-Pierre G, Belin MF, Pialat J, Lapras C: Structural and ultrastructural characteristics of human pineal gland, and pineal parenchymal tumors. Acta Neuropathol (Berl) 88: 334–348, 1994
Kuchelmeister K, von Borcke IM, Klein H, Bergmann M, Gullotta F: Pleomorphic pineocytoma with extensive neuronal differentiation: report of two cases. Acta Neuropathol (Berl) 88: 448–453, 1994
Numoto RT: Pineal parenchymal tumors: cell differentiation and prognosis. J Cancer Res Clin Oncol 120: 683–690, 1994
Perentes E, Rubinstein LJ, Herman MM, Donoso LA: S-antigen immunoreactivity in human pineal glands and pineal parenchymal tumors. A monoclonal antibody study. Acta Neuropathol (Berl) 71: 224–227, 1986
Mena H, Rushing EJ, Ribas JL, Delahunt B, McCarthy WF: Tumors of pineal parenchymal cells: a correlation of histological features, including nucleolar organizer regions, with survival in 35 cases. Hum Pathol 26: 20–30, 1995
Coca S, Vaquero J, Escandon J, Moreno M, Peralba J, Rodriguez J: Immunohistochemical characterization of pineocytomas. Clin Neuropathol 11: 298–303, 1992
Min K-W, Scheithauer BW, Bauserman SC: Pineal parenchymal tumors: ultrastructural study with prognostic implications. Ultrastruct Pathol 18: 69–85, 1994
Schild SE, Scheithauer BW, Haddock MG, Wong WW, Lyons MK, Marks LB, Norman MG, Burger PC: Histologically confirmed pineal tumors and other germ cell tumors of the brain. Cancer 78: 2564–2571, 1996
Stefanko SZ, Manschot WA: Pineoblastoma with retinoblastomatous differentiation. Brain 102: 3221–3332, 1979
Schmidbauer M, Budka H, Pilz P: Neuroepithelial and ectomesenchymal differentiation in a primitive pineal tumor ('pineal anlage tumor'). Clin Neuropathol 8: 7–10, 1989
Raisanen J, Vogel H, Horoupian DS: Primitive pineal tumor with retinoblastomatous and retinal/ciliary epithelial differentiation: an immunohistochemical study. J Neuro-Oncol 9: 165–170, 1990
Markesbery WR, Haugh RM, Young AB: Ultrastructure of pineal parenchymal neoplasms. Acta Neuropathol (Berl) 55: 143–149, 1981
Schild SE, Scheithauer BW, Schomberg PJ, Hook CC, Kelly PJ, Frick L, Robinow JS, Buskirk SJ: Pineal parenchymal tumors. Clinical, pathologic and therapeutic aspects. Cancer 72: 870–880, 1993
Mamourian AC, Towfighi J: Pineal cysts: MR imaging. AJNR Am J Neuroradiol 7: 1081–1086, 1986
Fain JS, Tomlinson FH, Scheithauer BW, Parisi JE, Fletcher GP, Kelly PJ, Miller GM: Symptomatic glial cysts of the pineal gland. J Neurosurg 80: 454–460, 1994
Mena H, Armonda RA, Ribas JL, Ondra SL, Rushing EJ: Nonneoplastic pineal cysts: a clinicopathologic study of twenty-one cases. Ann Diagn Pathol 1: 11–18, 1997
Vaquero J, Martinez R, Escandon J, Bravo G: Symptomatic glial cysts of the pineal gland. Surg Neurol 30: 468–470, 1988
Ringertz N, Nordenstam H, Flyger G: Tumors of the pineal region. J Neuropathol Exp Neurol 13: 540–561, 1954
Papasozomenos S, Shapiro S: Pineal astrocytoma: report of a case, confined to the epiphysis, with immunocytochemical and electron microscopic studies. Cancer 47: 99–103, 1981
DeGirolami U, Armbrustmacher VW: Juvenile pilocytic astrocytoma of the pineal region: report of a case. Cancer 50: 1185–1188, 1982
Norbut AM, Mendelow H: Primary glioblastoma multiform of the pineal region with leptomeningeal metastases: a case report. Cancer 47: 592–596, 1981
Scheithauer BW: Neuropathology of pineal region tumors. Clin Neurosurg 32: 351–383, 1985
Snipes GJ, Horoupian DS, Shuer LM, Silverberg GD: Pleomorphic granular cell astrocytoma. Cancer 70: 2159–2165, 1992
Tanaka M, Shibui S, Nomura K, Nakanishi Y: Pineal ganglioneuroblastoma in an adult. J Neuro-Oncol 44: 169–173, 1999
Tokoro K, Chiba Y, Ohtani T, Abe H, Yagishita S: Pineal ganglioglioma in a patient with familial basal ganglia calcification and elevated serum α-fetoprotein: case report. Neurosurgery 33: 506–511, 1993
Rubino GJ, King WA, Quinn B, Marroquin CE, Verity MA: Primary pineal melanoma: case report, Neurosurgery 33: 511–515, 1993
Smith WT, Hughes B, Ermocilla R: Chemodectoma of the pineal region, with observations on the pineal body and chemoreceptor tissue. J Pathol Bact 92: 69–76, 1966
Jennings MT, Gelman R, Hochberg F: Intracranial germcell tumors: natural history and pathogenesis. J Neurosurg 63: 155–167, 1985
Ho DM, Liu H-C: Primary intracranial germ cell tumor: pathologic study of 51 patients. Cancer 70: 1577–1584, 1992
Hoffman HJ, Otsubo H, Hendrick EB, Humphreys RP, Drake JM, Becker LE, Greenberg M, Jenkin D: Intracranial germ-cell tumors in children. J Neurosurg 74: 545–551, 1991
Ulbright TM, Amin MB, Young RT: Tumors of the testis, adnexa, spermatic cord, and scrotum. Atlas ofTumor Pathology, 3rd Series, Fascicle 25.Washington, DC Armed Forces Institute of Pathology, 1997
Kraichoke S, Cosgrove M, Chandrasoma PT: Granulomatous inflammation in pineal germinoma. A cause of diagnostic failure at stereotaxic brain biopsy. Am J Surg Pathol 12: 655–660, 1988
Nakagawa Y, Perentes E, Ross GW, Rubinstein LJ: Immunohistochemical differences between intracranial germinomas and their gonadal equivalents. An immunoperoxidase study of germ cell tumors with epithelial membrane antigen, cytokeratin, and vimentin. J Pathol 156: 67–72, 1988
Min KW, Scheithauer BW: Pineal germinomas and testicular seminoma: a comparative ultrastructural study with special references to early carcinomatous transformation: Ultrastruct Pathol 14: 483–496, 1990
Packer RJ, Sutton LN, Rorke LB, Rosenstock JG, Zimmerman RA, Littman P, Bilaniuk LT, Bruce DA, Schut L: Intracranial embryonal cell carcinoma. Cancer 54: 520–524, 1984
Burger PC, Scheithauer BW: Tumors of the central nervous system. Atlas of Tumor Pathology, 3rd Series, Fascicle 10. Washington, DC Armed Forces Institute of Pathology, 1994
Shaffrey ME, Lanzino G, Lopes MB, Hessler RB, Kassell NF, VandenBerg SR: Maturation of intracranial immature teratomas. Report of two cases. J Neurosurg 85: 672–676, 1996
O'Callaghan AM, Katapodis O, Ellison DW, Theaker JM, Mead GM: The growing teratoma syndrome in a nongerminomatous germ cell tumor of the pineal gland: a case report and review. Cancer 80: 942–947, 1997
Stein BM, Surgical treatment of pineal tumors. Clin Neurosurg 26: 490–510, 1979
Konovalov AN, Spallone A, Pitzkhelauri DI: Meningioma of the pineal region: a surgical series of 10 cases. J Neurosurg 85: 586–590, 1996
Roda JM, Perez-Higueras A, Oliver B, Alvarez MP, Blazquez MG: Pineal region meningiomas without dural attachment. Surg Neurol 17: 147–151, 1982
Rozario R, Adelman L, Prager RJ, Stein BM: Meningiomas of the pineal region and third ventricle. Neurosurgery 3: 489–495, 1979
Muller M, Hubbard SL, Provias J, Greenberg M, Becker LE, Rutka JT: Malignant rhabdoid tumour of the pineal region. Can J Neurol Sci 21: 273–277, 1994
Vaquero J, Martinez R, Magallon R, Ramiro J: Intracranial metastases to the pineal region. Report of three cases. J Neurosurg Sci 35: 55–57, 1991
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Hirato, J., Nakazato, Y. Pathology of pineal region tumors. J Neurooncol 54, 239–249 (2001). https://doi.org/10.1023/A:1012721723387
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DOI: https://doi.org/10.1023/A:1012721723387