The long‐term postsurgical prognosis of patients with pineoblastoma

Tate, Matthew C.; Sughrue, Michael E.; Rutkowski, Martin J.; Kane, Ari J.; Aranda, Derick; McClinton, LaShaun; McClinton, LaShay; Barani, Igor J.; Parsa, Andrew T.

doi:10.1002/cncr.26300

Cited by 80 publications

(84 citation statements)

References 65 publications

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“…Although they typically appear radiographically as a focal enhancing mass, pineoblastomas can be locally invasive and spread outside the pineal region through the subarachnoid space. Pineoblastomas are more common in children than in adults and adults account for <10% of patients [1]. …”

Section: Discussionmentioning

confidence: 99%

Tackling a Recurrent Pinealoblastoma

Palled

Kalavagunta

Gowda

et al. 2014

Case Reports in Oncological Medicine

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Pineoblastomas are rare, malignant, pineal region lesions that account for <0.1% of all intracranial tumors and can metastasize along the neuroaxis. Pineoblastomas are more common in children than in adults and adults account for <10% of patients. The management of pinealoblastoma is multimodality approach, surgery followed with radiation and chemotherapy. In view of aggressive nature few centres use high dose chemotherapy with autologus stem cell transplant in newly diagnosed cases but in recurrent setting the literature is very sparse. The present case represents the management of pinealoblastoma in the recurrent setting with reirradiation and adjuvant carmustine chemotherapy wherein the management guidelines are not definitive.

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Section: Discussionmentioning

confidence: 99%

Tackling a Recurrent Pinealoblastoma

Palled

Kalavagunta

Gowda

et al. 2014

Case Reports in Oncological Medicine

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“…Previous studies have reported that GTR may play a vital role in the treatment of PB (15,16). However, despite significant improvements in surgical techniques and perioperative care, a high risk is associated with surgical intervention in the pineal area owing to its proximity to critical structures.…”

Section: A B C D E F G Hmentioning

confidence: 99%

Complete regression of adult pineoblastoma following radiotherapy: A case report and review of the literature

Peng

Jiang

et al. 2015

Oncology Letters

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Abstract. Adult pineoblastomas (PBs) are rare central nervous system tumors. Little is known with regard to the clinical features and outcomes of adult PB, and optimal treatment strategies for adult PB remain to be determined. The current report describes a case of PB in a 46-year-old male, who presented with obstructive hydrocephalus due to a large pineal region mass. Considering the potential effect on quality of life, the patient underwent a partial resection. Postoperative radiotherapy, comprising prophylactic craniospinal irradiation at a dose of 34.2 Gy followed by a local 25.3-Gy 'boost' to the tumor site for a total dose of 59.5 Gy, resulted in the complete regression of the tumor without neurological deficits. The patient has remained free of recurrence for 36 months after radiotherapy. This case highlights a minimally invasive strategy to treat a rare pineal region tumor with significant involvement of critical structures that resulted in a favorable response and an excellent neurological outcome. The radiographic and histopathological features of PB are also reviewed, and the various treatment options reported in the literature are discussed. IntroductionPineal region tumors, which account for <1% of intracranial tumors (1), encompass a heterogeneous group of neoplasms that may be divided into four main categories: Germ cell tumors, glial cell tumors, pineal parenchymal tumors (PPTs) and other miscellaneous tumors and cysts. PPTs originate from cells in the pineal gland called pinealocytes, and represent only 0.3% of all primary tumors of the central nervous system (2). The current World Health Organization classification of PPTs includes well-differentiated pineocytoma (PC), PPT of intermediate differentiation and poorly differentiated pineoblastoma (PB) (3).PB is more common in children than in adults. It has been reported that the peak incidence of PB occurs in the first 4 years of life, with tendency to arise in the first and second decades (4). In addition, adult cases of PB account for <10% of published cases (5). Due to the rarity of PB, relevant data is limited, particularly regarding PB in adults. Thus, the biology, standard management and prognosis of PB are not well understood at present.The current report describes a case of PB occurring in a 46-year-old male who presented with obstructive hydrocephalus due to a large pineal region mass. This case highlights a minimally invasive strategy to treat a rare pineal region tumor with significant involvement of critical structures in an adult. Written informed consent was obtained from the patient. Case reportA 46-year old male was admitted to West China Hospital of West China Medical School (Sichuan University, Chengdu, China) in June 2011 with a 3-month history of mild headache, dizziness and impaired vision. No abnormalities were observed upon physical examination and laboratory tests. An ophthalmological exam revealed no evidence of papilledema.Computed tomography (CT) of the brain was performed, and a solid mass measuring 5 cm in diameter wa...

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“…Although craniospinal irradiation has been shown to prevent leptomeningeal recurrence, pineoblastomas are known to have a poor prognosis. 1 Pineoblastomas tend to recur on the surfaces of the neural tissue rather than in the parenchyma and all the lesions identified in the patient were far from the pineal gland, although there are case reports of brain metastasis related to the manipulation of a pineoblastoma after stereotactic or endoscopic biopsy. 2 In this case, tumor recurrence was considered after the first MRI showing white matter changes, but the subsequent improvement without specific treatment is not expected in a malignant condition.…”

Section: Sectionmentioning

confidence: 95%

Clinical Reasoning: Left hemiparesis, ataxia, and optic neuritis in a child previously treated for pineoblastoma

et al. 2016

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A 13-year-old girl presented acutely with an episode of headache and signs of elevated intracranial pressure from a pineal gland tumor causing obstructive hydrocephalus. After an endoscopic third ventriculostomy and pineal gland biopsy, she was diagnosed with pineoblastoma. She was treated with surgical resection, craniospinal radiotherapy, and subsequent chemotherapy. Brain MRIs were performed every 3 months after surgery and remained stable with no new lesions or signs of residual tumor. However, a follow-up brain MRI performed 6 months after chemotherapy showed some small white matter nonenhancing lesions in supratentorial subcortical areas and within the cord at C7. She had no neurologic symptoms at that time and the white matter lesions improved over the next 3 months.However, 10 months later, she developed acute weakness of her left arm and leg and blurry vision. Her neurologic examination confirmed left optic neuritis and moderate left hemiparesis. Routine laboratories did not show any abnormalities. A new brain MRI showed new and enhancing lesions in the brain and spinal cord, including cerebellar hemispheres, left cerebellar peduncle, subcortical white matter, left optic nerve, and multilevel (thoracic and lumbar) intramedullary spinal cord lesions ( figure, A and B). Some of them were round and had a complete ring-enhancing pattern. Additional MRI sequences such as diffusionweighted imaging and perfusion-weighted imaging did not clarify the nature of the lesions (normal apparent diffusion coefficient [ADC] values and slightly increased perfusion in enhancing areas). Spectroscopy was normal. Magnetic resonance angiography demonstrated no flow-limiting stenosis. The patient and her family declined a lumbar puncture. She was empirically treated with high-dose IV steroids and her examination results returned to normal after 6-8 weeks.Question for consideration:1. What is your differential diagnosis regarding her second neurologic presentation?GO TO SECTION 2

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The long‐term postsurgical prognosis of patients with pineoblastoma

Cited by 80 publications

References 65 publications

Tackling a Recurrent Pinealoblastoma

Tackling a Recurrent Pinealoblastoma

Complete regression of adult pineoblastoma following radiotherapy: A case report and review of the literature

Clinical Reasoning: Left hemiparesis, ataxia, and optic neuritis in a child previously treated for pineoblastoma

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