Available online 8 February 2013
Publication year: 2013
Source:World Neurosurgery
Object Pineal parenchymal tumors of intermediate differentiation (PPTID) are extremely rare tumor entities and only limited data are available regarding their pathologic features and biologic behaviors. Because grading criteria of pineal parenchymal tumors (PPTs) has yet to be established, the treatment strategy and prognosis of PPTIDs remain controversial. We describe the clinicopathological study of six patients with PPTID and compare responses for the treatment and prognosis with cases of pineocytoma (PC) and pineoblastoma (PB). From this analysis, we attempt to clarify the treatment strategy for PPTIDs. Methods This study included 15 patients with PPTs, consisting of 6 PCs, 6 PPTIDs, and 3 PBs. We focused on the six patients with PPTIDs. All PPTID cases were treated surgically and radiotherapy and chemotherapy were administered as adjuvant therapies in some cases. For histopathological study, we have already reported.8 Briefly, we examined mitotic figures and necrosis by H&E staining and immunohistochemical markers such as neuronal markers (synaptophysin (SY), neurofilament (NF), and NeuN) and a MIB-1 labeling index (LI) was determined. Results In the PPTID cases, the extent of resection was variable and the recurrence rates among patients varied according to stage and treatment. All PC patients underwent total resection with no recurrence. All PB patients underwent resection and adjuvant therapy with radiotherapy and chemotherapy. There were no recurrences in patients with PC or PB. The results of histopathological findings have been already reported.8 Briefly, the results indicated no mitotic figure or necrosis in any of the six cases of PPTID, but those features were observed in PB cases. All cases even including PC and PB were immunopositive for neuronal markers. The MIB-1 LI of PPTID was 3.5%, whereas that was 0% in PC and 10.5% in PB. Conclusions Good radiosensitivity of PPTIDs was observed in our series. Because there are cases with discrepancies between images and pathological findings, it is very difficult to determine the proper treatment strategy for PPTIDs. Proliferative potential was correlated with WHO grade, although the immunoreactivity of neuronal markers did not correlate with the histological grade.
Júlio Leonardo B. Pereira
Phone: (+1) 424-2301706
Linkedin:http://www.linkedin.com/in/juliommais
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