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Identification of characteristic features of pineal germinoma that enhance accuracy of preoperative differentiation in pineal region tumors: its significance on optimum surgical treatment

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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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References

  1. Ai P, Peng X, Jiang Y, Zhang H, Wang S, Wei Y (2015) Complete regression of adult pineoblastoma following radiotherapy: a case report and review of the literature. Oncol Lett 10(4):2329–2332

    PubMed  PubMed Central  Google Scholar 

  2. Awa R, Campos F, Arita K, Sugiyama K, Tomonaga A, Kurisu K, Yamasaki F, Karki P, Tokimura H, Fukukura Y, Fujii Y, Hanaka R, Oyoshi T, Hirano H (2014) Neuroimaging diagnosis of pineal region tumors-quest for pathognomonic finding of germinoma. Neuroradiology 56(7):525–534

    Article  PubMed  Google Scholar 

  3. Büttner-Ennever JA, Büttner U, Cohen B, Baumgartner G (1982) Vertical glaze paralysis and the rostral interstitial nucleus of the medial longitudinal fasciculus. Brain 105(1):125–149

    Article  PubMed  Google Scholar 

  4. Bogousslavsky J, Miklossy J, Regli F, Janzer R (1990) Vertical gaze palsy and selective unilateral infarction of the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). J Neurol Neurosurg Psychiatry 53(1):67–71

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Chibbaro S, Di Rocco F, Makiese O, Reiss A, Poczos P, Mirone G, Servadei F, George B, Crafa P, Polivka M, Romano A (2012) Neuroendoscopic management of posterior third ventricle and pineal region tumors: technique, limitation, and possible complication avoidance. Neurosurg Rev 35(3):331–338

    Article  CAS  PubMed  Google Scholar 

  6. Cogan D (1974) Paralysis of downgaze. Arch Ophthalmol 91(3):192–199

    Article  CAS  PubMed  Google Scholar 

  7. Dumrongpisutikul N, Intrapiromkul J, Yousem DM (2012) Distingushing between germinomas and pineal cell tumors on MR imaging. AJNR 33(3):550–555

    Article  CAS  PubMed  Google Scholar 

  8. Fèvre-Montange M, Vasiljevic A, Champier J, Jouvet A (2010) Histopathology of tumors of the pineal region. Future Oncol 6(5):791–809

    Article  PubMed  Google Scholar 

  9. Herrada-Pineda T, Revilla-Pacheco F, Manrique-Guzman S (2015) Endoscopic approach for the treatment of pineal region tumors. J Neurol Surg A Cent Eur Neurosurg 76(1):8–12

    PubMed  Google Scholar 

  10. Hoffman HJ, Otsubo H, Hendrick EB, Humphreys RP, Drake JM, Becker LE, Greenberg M, Jenkin D (1991) Intracranial germ-cell tumors in children. J Neurosurg 74(4):545–551

    Article  CAS  PubMed  Google Scholar 

  11. Kakigi T, Okada T, Kanagaki M, Yamamoto A, Fushimi Y, Sakamoto R, Arakawa Y, Mikami Y, Shimono T, Takahashi JC, Togashi K (2014) Quantitative imaging values of CT, MR, and FDG-PET to differentiate pineal parenchymal tumors and germinomas: are they useful? Neuroradiology 56(4):297–303

    Article  PubMed  Google Scholar 

  12. Kamoshima Y, Sawamura Y (2010) Update on current standard treatments in central nervous system germ cell tumors. Curr Opin Neurol 23(6):571–575

    Article  PubMed  Google Scholar 

  13. Konovalov AN, Pitskhelauri DI (2003) Principles of treatment of the pineal region tumors. Surg Neurol 59(4):250–268

    Article  PubMed  Google Scholar 

  14. Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, Seto T (1997) Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 86(3):446–455

    Article  CAS  PubMed  Google Scholar 

  15. Miškovská V, Usakova V, Vertakova-Krakovska B, Mrinakova B, Lehotská V, Chorváth M, Rychlý B, Steno J, Ondruš D (2013) Pineal germ cell tumors: review. Klin Onkol 26(1):19–24

    Article  PubMed  Google Scholar 

  16. Pierrot-Deseilligny C (1985) Central oculomotor circuits. Rev Neurol (Paris) 141(5):349–370

    CAS  Google Scholar 

  17. Saito R, Kumabe T, Kanamori M, Sonoda Y, Watanabe M, Mugikura S, Takahashi S, Tominaga T (2014) Early response to chemotherapy as an indicator for the management of germinoma-like tumors of the pineal and/or suprasellar regions. J Clin Neurosci 21(1):124–130

    Article  CAS  PubMed  Google Scholar 

  18. Shibamoto Y, Abe M, Yamashita J, Takahashi M, Hiraoka M, Ono K, Tsutsui K (1988) Treatment results of intracranial germinoma as a function of the irradiated volume. Int J Radiat Oncol Biol Phys 15(2):285–290

    Article  CAS  PubMed  Google Scholar 

  19. Wang Y, Zou L, Gao B (2010) Intracranial germinoma: clinical and MRI findings in 56 patients. Childs Nev Syst 26(12):1773–1777

    Article  Google Scholar 

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Acknowledgements

The authors would like to express their gratitude to Taichi Furumochi and Yasuhiro Shiraishi of the Department of Neurology, Ehime University Hospital, Japan, for their helpful information regarding radiological image acquisition.

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Authors and Affiliations

  1. Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan

    Akihiro Inoue, Shohei Kohno, Shirabe Matsumoto, Masahiro Nishikawa & Takeharu Kunieda

  2. Department of Neurosurgery, Washoukai Sadamoto Hospital, 1-6-1 Takehara, Matsuyama, Ehime, 790-0052, Japan

    Takanori Ohnishi

  3. Department of Neurosurgery, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan

    Shiro Ohue, Shinji Iwata & Saya Ozaki

  4. Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan

    Yosuke Mizuno & Riko Kitazawa

Authors
  1. Akihiro Inoue
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  2. Takanori Ohnishi
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  3. Shohei Kohno
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  4. Shiro Ohue
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  5. Shinji Iwata
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  6. Shirabe Matsumoto
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  7. Masahiro Nishikawa
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  8. Saya Ozaki
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  9. Yosuke Mizuno
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  10. Riko Kitazawa
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  11. Takeharu Kunieda
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Correspondence to Akihiro Inoue.

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The authors declare that there are no conflicts of interest regarding the publication of this paper. None of the authors has any financial interest in this work.

Human and animal rights and informed consent

The clinical study of the following studies was approved by the Ethics Committee for Clinical Research of Ehime University Hospital prior to initiating the study. Informed consent was obtained from each patient prior to initiating the study.

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Inoue, A., Ohnishi, T., Kohno, S. et al. 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 41, 197–206 (2018). https://doi.org/10.1007/s10143-017-0835-y

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  • DOI: https://doi.org/10.1007/s10143-017-0835-y

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