Pineal Bölge Tümörleri: Tek Merkez Deneyimi

Abstract

Yetişkinlerde tüm intrakraniyal tümörlerin %1'inden azını, pediatrik grupta ise %3-11'ini oluşturan pineal bölge tümörleri oldukça heterojen bir gruptur. Bölgenin tümör ve lezyonlarını genel bir başlık altında toplayarak dört gruba ayırmak mümkündür. Bunlar germ hücreleri tümörler, pineal parankimal tümörler ve glioma gibi komşu yapılardan kaynaklanan tümörler ve diğerleri şeklindedir. Çalışmamıza merkezimizde 2005-2020 yılları arasında opere edilmiş tüm pineal bölge tümörleri dahil edildi. Olguların demografik bilgileri, ön tanı, tümör çapı, klinik ve radyolojik bilgileri, sağkalım durumu, nüks varlığı ve son kontrol tarihleri hastane veritabanından ve patoloji raporlarından elde edildi. Çalışmaya dahil edilen olgulara ait hematoksilen eozin boyalı preparatlar ile mevcutsa immünohistokimyasal ve histokimyasal çalışma yapılan preparatlar histopatolojik tanı ve grade açısından yeniden değerlendirildi. Olguların histopatolojik değerlendirmesinde 6 (%22,2) olgu menengioma, 5 (%18,5) olgu pineoblastoma, 4 (%14,8) olgu pineositoma, 2 (%7,4) olgu pineal bölgenin papiller tümörü, 2 (%7,4) olgu orta derecede farklılaşma gösteren pineal parankimal tümör, 2 (%7,4) olgu glioblastoma, 2 (%7,4) olgu germ hücreli tümör (germinoma ve matür kistik teratoma), 1 (%3,7) olgu oligodenrioglioma, 1 (%3,7) olgu pilositik astrositoma, 1 (%3,7) olgu metastatik karsinoma ve 1 (%3,7) olgu gliozis ve hemosiderin pigment birikimi şeklinde tanı aldı. Pineal bölge çeşitli benign ve malign natürde tümörlerin gözlenebildiği özel bir lokalizasyondur. Histopatolojik değerlendirme yapılmadan önce mutlaka olgunun klinik, laboratuvar ve radyolojik verilerine hakim olunmalıdır. Mikroskobik değerlendirme bölgenin sahip olduğu geniş tanı yelpazesi göz önünde bulundurularak, yapılmalı ve gerekli durumlarda immünohistokimyasal ve histokimyasal çalışmalardan yardım alınmalıdır.

Keywords

• Pineal bölge
• Glioma
• Patoloji
• Pineal bez

Tumors of Pineal Region: A Single-Institution Experience

Abstract

Tumors of pineal region constitute less than 1% of all intracranial tumors in adults and 3-11% in the pediatric patients. The tumors of this region can be divided into four groups as germ cells tumors, pineal parenchymal tumors and tumors originating from neighboring structures such as gliomas and others. The study includes pineal region tumors diagnosed in our center between 2005 and 2020. Demographic information, pre-diagnosis, tumor size, clinical and radiological information, presence of recurrence, survival status, and last follow-up dates were obtained from the hospital database and pathology reports. Hematoxylin-eosin stained slides and if available, immunohistochemically and histochemically stained slides were re-evaluated in terms of histopathological diagnosis and grade. Histopathological diagnosis of 6 (22.2%) cases were meningioma, 5 (18.5%) were pineoblastoma, 4 (14.8%) were pineocytoma, 2 (7.4%) were papillary tumor of the pineal region, 2 (7.4%) were pineal parenchymal tumor with intermediate differentiation, 2 (7.4%) were glioblastoma, 2 (7.4%) were germ cell tumor (germinoma and mature cystic teratoma), 1 (3.7%) was oligodenrioglioma, 1 (3.7%) was pilocytic astrocytoma, 1 (3.7%) was metastatic carcinoma and 1 (3.7%) case was gliosis and hemosiderin pigment accumulation. The pineal region is a distinctive area where various benign and malignant tumors occur. Before performing histopathological evaluation, the clinical, laboratory and radiological information of patients should be taken into consideration. The wide diagnostic spectrum of the region must be kept in mind and aid from immunohistochemical and histochemical studies should be obtained when necessary.

Keywords

• Glioma
• Pathology
• Pineal gland
• Pineal region

References

1. 1. Han SJ, Clark AJ, Ivan ME, Parsa AT, Perry A. Pathology of pineal parenchymal tumors. Neurosurg Clin N Am. 2011 Jul;22(3):335-40, vii. doi: 10.1016/j.nec.2011.05.006.
2. 2. Chaturvedi S, Suri V. Pineal tumors: Rare but challenging entity. Neurol India. Mar-Apr 2019;67(2):503-504. doi: 10.4103/0028-3886.258023.
3. 3. Tamrazi B, Nelson M, Blüml S. Pineal Region Masses in Pediatric Patients. Neuroimaging Clin N Am. 2017 Feb;27(1):85-97. doi: 10.1016/j.nic.2016.08.002.
4. 4. Vasiljevic A, Szathmari A, Champier J, Fèvre-Montange M, Jouvet A. Histopathology of pineal germ cell tumors. Neurochirurgie. Apr-Jun 2015;61(2-3):130-7. doi: 10.1016/j.neuchi.2013.06.006.
5. 5. WHO Classification of Tumours Editorial Board. World Health Organization Classification of Tumours of the Central Nervous System. 5th ed. Lyon: International Agency for Research on Cancer; 2021.
6. 6. Li D, Wen R, Gao Y, et al. Pineal Region Gliomas: A Single-Center Experience with 25 Cases. World Neurosurg. 2020 Jan;133:e6-e17. doi: 10.1016/j.wneu.2019.06.189.
7. 7. Jouvet A, Vasiljevic A, Champier J, Montange MF. Pineal parenchymal tumours and pineal cysts. Neurochirurgie. Apr-Jun 2015;61(2-3):123-9. doi: 10.1016/j.neuchi.2013.04.003.
8. 8. Lamis FC, de Paiva Neto MA, Stavale JN, Cavalheiro S. Low-Grade Oligodendroglioma of the Pineal Region: Case Report. J Neurol Surg Rep. 2015 Jul;76(1):e55-8. doi: 10.1055/s-0034-1396653.

9. 9. Carr C, O'Neill BE, Hochhalter CB, Strong MJ, Ware ML. Biomarkers of Pineal Region Tumors: A Review. Ochsner J. 2019 Spring;19(1):26-31. doi: 10.31486/toj.18.0110.
10. 10. Parker JJ, Waziri A. Preoperative evaluation of pineal tumors. Neurosurg Clin N Am. 2011 Jul;22(3):353-8, vii-viii. doi: 10.1016/j.nec.2011.04.003.
11. 11. Roth J, Kozyrev DA, Richetta C, Dvir R, Constantini S. Pineal region tumors: an entity with crucial anatomical nuances. Child Nerv Syst. 2021 Feb;37(2):383-390.
12. 12. Malik Noor, Samples DC, Finneran MM, Graber S, Dorris K, Norris G, Foreman NK, Hankinson TC, Handler MH. Pediatric pineal region masses: a single-center experience over 25 years. Childs Nerv Syst. 2023 Sep;39(9):2307-2316
13. 13. Patel S, Rahmani B, Gandhi J, et al. Revisiting the pineal gland: a review of calcification, masses, precocious puberty, and melatonin functions. Int J Neurosci. 2020 May;130(5):464-475. doi: 10.1080/00207454.2019.1692838.
14. 14. Kondo A, Suzuki M, Shimizu Y, Akiyama O. The surgical intervention for pineal region tumors. Childs Nerv Syst. 2023 Sep;39(9):2341:2348.
15. 15. Li D, Rong W, Gao Y, Xu Y, Xiong B, Gong F, Wang W. Pineal Region Gliomas: A Single-Center Experience with 25 Cases. World Neurosurg. 2020 Jan:133:e6-e17.
16. 16. Fetcko K, Dey M. Primary Central Nervous System Germ Cell Tumors: A review and Update. Med Res Arch. 2018 Mar;6(3):1719.
17. 17. Takami H, Fukuoka K, Fukushima S, et al. Integrated clinical, histopathological, and molecular data analysis of 190 central nervous system germ cell tumors from the iGCT Consortium. Neuro Oncol. 2019 Dec 17;21(12):1565-1577. doi: 10.1093/neuonc/noz139.
18. 18. Nagasawa DT, Lagman C, Sun M, et al. Pineal germ cell tumors: Two cases with review of histopathologies and biomarkers. J Clin Neurosci. 2017 Apr;38:23-31. doi: 10.1016/j.jocn.2016.12.024.
19. 19. Matsutani M. Pineal germ cell tumors. Prog Neurol Surg. 2009;23:76-85. doi: 10.1159/000210054.
20. 20. Favero G, Bonomini F, Rezzani R. Pineal Gland Tumors: A Review. Cancers (Basel):2021 Mar;13(7):1547.
21. 21. Verma A, Epari S, Bakiratharajan D, et al. Primary pineal tumors - Unraveling histological challenges and certain clinical myths. Neurol India. Mar-Apr 2019;67(2):491-502. doi: 10.4103/0028-3886.258045.
22. 22. Fevre-Montange M, Vasiljevic A, Frappaz D, et al. Utility of Ki67 immunostaining in the grading of pineal parenchymal tumours: A multicentre study. Neuropathol Appl Neurobiol 2012;38:87-94.
23. 23. Magrini S, Feletti A, Marton E, Longatti P. Gliomas of the pineal region. J Neurooncol. 2013 Oct;115(1):103-11. doi: 10.1007/s11060-013-1200-9.
24. 24. Abecassis IJ, Hanak B, Barber J, Mortazavi M, Ellenbogen RG. A Single-Institution Experience with Pineal Region Tumors: 50 Tumors Over 1 Decade. Oper Neurosurg (Hagerstown). 2017 Oct 1;13(5):566-575. doi: 10.1093/ons/opx038.