Metastases in the Pineal Region: A Systematic Review of Clinical Features, Management Strategies, and Survival Outcomes

Palmisciano, Paolo; Ogasawara, Christian; Nwagwu, Chibueze D.; Bin-Alamer, Othman; Gupta, Aditya; Larsen, Alexandra Giantini; Scalia, Gianluca; Yu, Kenny; Umana, Giuseppe Emmanuele; Cohen-Gadol, Aaron; Ahmadieh, Tarek Y. El; Haider, Ali S

doi:10.1016/j.wneu.2022.01.005

Cited by 6 publications

(3 citation statements)

References 71 publications

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“…The lack of protection conversely may allow for an increased risk of metastases from the lung (most commonly), breast, gastrointestinal tract, kidney, skin, and other documented sites. 13 In spite of the current patient's smoking habits and history of invasive breast cancer, the respective absence of TTF1 and keratin (AE1/AE3) immunoreactivity (Figure 2C and D) lessened the likelihood of small-cell and non-small-cell lung cancer or breast cancer origins. Next of note, there are no distinguishing features on MRI to distinguish germinomas, the most common pineal region tumor, from pineal cell tumors, 14 and all may cause compression of surrounding structures with resultant obstructive hydrocephalus.…”

Section: Discussionmentioning

confidence: 94%

A Pineal Parenchymal Tumor of Intermediate Differentiation in an Octogenarian Contains a Rare KBTBD4 Insertion

Jones,

Kanter,

Russo

et al. 2023

Int J Surg Pathol

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Pineal parenchymal tumors are rare central nervous system tumors that pose diagnostic challenges for surgical pathologists. Due to their paucity, their clinicopathologic features are still being defined. We report an 86-year-old woman with a remote history of breast lobular carcinoma who presented with a 2-month neurologic history that included gait instability, blurry vision, and headaches. Magnetic resonance imaging revealed a lobular, heterogeneously enhancing pineal region mass compressing the aqueduct of Sylvius. A biopsy performed concomitant with endoscopic third ventriculostomy consisted of small sheets of cells with eosinophilic to clear cytoplasm, multipolar processes, and ovoid nuclei with stippled chromatin. Whole exome sequencing revealed a small in-frame insertion (duplication) in exon 4 of KBTBD4 (c.931_939dup, p.P311_R313dup/ p.R313_M314insPRR), which has very recently been reported in 2 pineal parenchymal tumors of intermediate differentiation (PPTID). Additionally, variants of uncertain significance in CEBPA (c.863G > C, p.R288P) and MYC (c.655T > C, p.S219P) were identified. Although PPTID is considered a disease of young adulthood, review of 2 institutional cohorts of patients with pineal region tumors revealed that 25% of individuals with PPTID were over 65 years of age. In conclusion, PPTID should be considered in the differential diagnosis of pineal region tumors in older adults.

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Section: Discussionmentioning

confidence: 94%

A Pineal Parenchymal Tumor of Intermediate Differentiation in an Octogenarian Contains a Rare KBTBD4 Insertion

Jones,

Kanter,

Russo

et al. 2023

Int J Surg Pathol

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“…Germinomas are the most common type of pineal tumor, but all the different histotypes may be present, including choriocarcinomas, teratomas, embryonal carcinomas, yolk sac tumors, and mixed germ cell tumors [ 3 ]. Other tumors, including metastatic cancer spreading to the pineal gland, are exceedingly uncommon [ 4 , 5 , 6 ].…”

Section: Pathological and Molecular Featuresmentioning

confidence: 99%

“…Tumors of the pineal region (PRT) are rare, accounting for less than 1% of all intracranial tumor lesions, and represent a histologically heterogeneous group of tumors, including primary pineal parenchymal tumors, germ cell tumors (GCT), and tumors originating from the adjacent structures, such as choroid plexus tumors, meningiomas, and gliomas [ 3 ]. Lymphomas, atypical teratoid rhabdoid tumor (ATRT), and metastases may also occur in this region, though they are uncommon (see Figure 1 ) [ 4 , 5 , 6 ]. Pineal parenchymal tumors and germ cell tumors together make up more than 70% of all pineal region tumors [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Treatment of Pineal Region Tumors in Adults: A EURACAN Overview

Lombardi

Poliani

Manara

et al. 2022

Cancers

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Pineal region tumors are rare intracranial tumors, accounting for less than 1% of all adult intracranial tumor lesions. These lesions represent a histologically heterogeneous group of tumors. Among these tumors, pineal parenchymal tumors and germ cell tumors (GCT) represent the most frequent types of lesions. According to the new WHO 2021 classification, pineal parenchymal tumors include five distinct histotypes: pineocytoma (PC), pineal parenchymal tumors of intermediate differentiation (PPTID), papillary tumor of the pineal region (PTPR), pinealoblastoma (PB), and desmoplastic myxoid tumor of the pineal region, SMARCB1-mutant; GCTs include germinoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, mixed GCTs. Neuroradiological assessment has a pivotal role in the diagnostic work-up, surgical planning, and follow-up of patients with pineal masses. Surgery can represent the mainstay of treatment, ranging from biopsy to gross total resection, yet pineal region tumors associated with obstructive hydrocephalus may be surgically managed via ventricular internal shunt or endoscopic third ventriculostomy. Radiotherapy remains an essential component of the multidisciplinary treatment approach for most pineal region tumors; however, treatment volumes depend on the histological subtypes, grading, extent of disease, and the combination with chemotherapy. For localized germinoma, the current standard of care is chemotherapy followed by reduced-dose whole ventricular irradiation plus a boost to the primary tumor. For pinealoblastoma patients, postoperative radiation has been associated with higher overall survival. For the other pineal tumors, the role of radiotherapy remains poorly studied and it is usually reserved for aggressive (grade 3) or recurrent tumors. The use of systemic treatments mainly depends on histology and prognostic factors such as residual disease and metastases. For pinealoblastoma patients, chemotherapy protocols are based on various alkylating or platinum-based agents, vincristine, etoposide, cyclophosphamide and are used in association with radiotherapy. About GCTs, their chemosensitivity is well known and is based on cisplatin or carboplatin and may include etoposide, cyclophosphamide, or ifosfamide prior to irradiation. Similar regimens containing platinum derivatives are also used for non-germinomatous GCTs with very encouraging results. However, due to a greater understanding of the biology of the disease’s various molecular subtypes, new agents based on targeted therapy are expected in the future. On behalf of the EURACAN domain 10 group, we reviewed the most important and recent developments in histopathological characteristics, neuro-radiological assessments, and treatments for pineal region tumors.

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The role of cesium-131 brachytherapy in brain tumors: a scoping review of the literature and ongoing clinical trials

et al. 2022

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Metastases in the Pineal Region: A Systematic Review of Clinical Features, Management Strategies, and Survival Outcomes

Cited by 6 publications

References 71 publications

A Pineal Parenchymal Tumor of Intermediate Differentiation in an Octogenarian Contains a Rare KBTBD4 Insertion

A Pineal Parenchymal Tumor of Intermediate Differentiation in an Octogenarian Contains a Rare KBTBD4 Insertion

Diagnosis and Treatment of Pineal Region Tumors in Adults: A EURACAN Overview

The role of cesium-131 brachytherapy in brain tumors: a scoping review of the literature and ongoing clinical trials

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