Atypical Pleomorphic Neoplasms of the Pineal Gland: Case Report and Review of the Literature

Overview

Journal Surg Neurol Int

Specialty Neurology

Date 2015 Aug 11

PMID 26257987

Citations 4

Authors

M Praver

R DAmico

C Arraez

B E Zacharia

H Varma

J E Goldman

J N Bruce

P Canoll

Affiliations

Soon will be listed here.

Abstract

Background: Pineal region tumors are rare and diverse. Among them exist reports of pleomorphic xanthroastrocytoma (PXA) and pleomorphic granular cell astrocytoma (PGCA) of the pineal gland. These related tumors are remarkably similar sharing pleomorphic histologic features with only minor immunohistochemical and ultrastructural differences.

Case Description: We present a case of a 42-year old right-handed woman presented with a longstanding history of migraine headaches which had worsened over the two months leading up to her hospitalization. MRI revealed a 1.7 × 1.3 × 1.6 cm intensely enhancing lesion originating in the pineal gland. The tumor closely resembled PGCA but did not strictly fit the diagnostic requirements of either PGCA or PXA.

Conclusion: The present case highlights the exotic nature of pineal region tumors with pleomorphic cell histology. Given the diverse range of tumors encountered in the pineal region, pathological confirmation is mandatory. Favorable clinical outcomes demonstrate that surgical resection alone can yield excellent long-term results for tumors falling within the spectrum of pleomorphic lesions of the pineal gland.

Citing Articles

Radiological Insights From Two Distinct Cases of Pineal Region Meningioma: A Case Report.

Ravipati C, Vikram M, Ramakrishnan K, Malaichamy A Cureus. 2024; 16(4):e57796.

PMID: 38721197 PMC: 11077486. DOI: 10.7759/cureus.57796.

Pineal region ganglioglioma: A neoplasm with a bimodal age distribution.

Al-Dalahmah O, Wang L, Hsiao S, Lin C, Mansukhani M, Canoll P Surg Neurol Int. 2022; 13:245.

PMID: 35855114 PMC: 9282777. DOI: 10.25259/SNI_443_2022.

A Rare Case of Atypical Pleomorphic Neoplasm of Pineal Region in a Child: A Case Report.

Kataria S, Neupane K, Ahmed Z, Noor E, Rehman U Cureus. 2020; 12(9):e10515.

PMID: 33094056 PMC: 7571780. DOI: 10.7759/cureus.10515.

Pineal region pilocytic astrocytoma; an unusual site with variable radiological, clinical, and histological features: A report of two cases.

Gupta R, Batra V, Jagetia A, Singh D J Neurosci Rural Pract. 2016; 7(3):459-62.

PMID: 27365971 PMC: 4898122. DOI: 10.4103/0976-3147.182780.

References

Giannini C, Scheithauer B, Lopes M, Hirose T, Kros J, VandenBerg S . Immunophenotype of pleomorphic xanthoastrocytoma. Am J Surg Pathol. 2002; 26(4):479-85. DOI: 10.1097/00000478-200204000-00010. View

Kurschel S, Lellouch-Tubiana A, Kulkarni A, Sainte-Rose C . Pleomorphic xanthoastrocytoma of the cerebellopontine angle in a child. Childs Nerv Syst. 2006; 22(11):1479-82. DOI: 10.1007/s00381-006-0164-x. View

Gil-Gouveia R, Cristino N, Farias J, Trindade A, Ruivo N, Pimentel J . Pleomorphic xanthoastrocytoma of the cerebellum: illustrated review. Acta Neurochir (Wien). 2004; 146(11):1241-4. DOI: 10.1007/s00701-004-0366-5. View

Bruce J, STEIN B . Surgical management of pineal region tumors. Acta Neurochir (Wien). 1995; 134(3-4):130-5. DOI: 10.1007/BF01417679. View

Giannini C, Scheithauer B, Burger P, Brat D, Wollan P, Lach B . Pleomorphic xanthoastrocytoma: what do we really know about it?. Cancer. 1999; 85(9):2033-45. View

ZULCH K . Reflections on the surgery of the pineal gland (a glimpse into the past). Gleanings from medical history. Neurosurg Rev. 1981; 4(3):159-63. DOI: 10.1007/BF01743642. View

Naidich M, Walker M, Gottardi-Littell N, Han G, CHANDLER J . Cerebellar pleomorphic xanthoastrocytoma in a patient with neurofibromatosis type 1. Neuroradiology. 2004; 46(10):825-9. DOI: 10.1007/s00234-004-1216-0. View

Ohta T, Yachi K, Ogino A, Yokoyama T, Fukushima T, Watanabe T . Pleomorphic granular cell astrocytoma in the pineal gland: case report. Neuropathology. 2010; 30(6):615-20. DOI: 10.1111/j.1440-1789.2009.01095.x. View

Katayama K, Asano K, Shimamura N, Ogasawara Y, Naraoka M, Ohkuma H . Case of pleomorphic xanthoastrocytoma with anaplastic features in the pineal gland. Brain Tumor Pathol. 2013; 30(4):242-6. DOI: 10.1007/s10014-013-0137-1. View

10.

Srinivas B, Uppin M, Panigrahi M, Saradhi M, Jyotsna Rani Y, Challa S . Pleomorphic xanthoastrocytoma of the pineal region. J Clin Neurosci. 2010; 17(11):1439-41. DOI: 10.1016/j.jocn.2010.02.022. View

11.

Thakkar J, Chew L, Villano J . Primary CNS germ cell tumors: current epidemiology and update on treatment. Med Oncol. 2013; 30(2):496. DOI: 10.1007/s12032-013-0496-9. View

12.

OBrien D, Hayhurst C, Pizer B, Mallucci C . Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus. J Neurosurg. 2006; 105(3 Suppl):219-26. DOI: 10.3171/ped.2006.105.3.219. View

13.

Vu T, Liubinas S, Gonzales M, Drummond K . Malignant potential of pleomorphic xanthoastrocytoma. J Clin Neurosci. 2011; 19(1):12-20. DOI: 10.1016/j.jocn.2011.07.015. View

14.

Chang H, Latorre J, Hahn S, Dubowy R, Schelper R . Pediatric cerebellar pleomorphic xanthoastrocytoma with anaplastic features: a case of long-term survival after multimodality therapy. Childs Nerv Syst. 2006; 22(6):609-13. DOI: 10.1007/s00381-005-0005-3. View

15.

Al-Tamimi Y, Bhargava D, Surash S, Ramirez R, Novegno F, Crimmins D . Endoscopic biopsy during third ventriculostomy in paediatric pineal region tumours. Childs Nerv Syst. 2008; 24(11):1323-6. DOI: 10.1007/s00381-008-0632-6. View

16.

Blakeley J, Grossman S . Management of pineal region tumors. Curr Treat Options Oncol. 2006; 7(6):505-16. DOI: 10.1007/s11864-006-0025-6. View

17.

Kumar S, Retnam T, Menon G, Nair S, Bhattacharya R, Radhakrishnan V . Cerebellar hemisphere, an uncommon location for pleomorphic xanthoastrocytoma and lipidized glioblastoma multiformis. Neurol India. 2003; 51(2):246-7. View

18.

Snipes G, Horoupian D, Shuer L, Silverberg G . Pleomorphic granular cell astrocytoma of the pineal gland. Cancer. 1992; 70(8):2159-65. DOI: 10.1002/1097-0142(19921015)70:8<2159::aid-cncr2820700825>3.0.co;2-c. View

19.

Saikali S, Le Strat A, Heckly A, Stock N, Scarabin J, Hamlat A . Multicentric pleomorphic xanthoastrocytoma in a patient with neurofibromatosis type 1. Case report and review of the literature. J Neurosurg. 2005; 102(2):376-81. DOI: 10.3171/jns.2005.102.2.0376. View

20.

KEPES J, Rubinstein L, Eng L . Pleomorphic xanthoastrocytoma: a distinctive meningocerebral glioma of young subjects with relatively favorable prognosis. A study of 12 cases. Cancer. 1979; 44(5):1839-52. DOI: 10.1002/1097-0142(197911)44:5<1839::aid-cncr2820440543>3.0.co;2-0. View