Malignant pineal region tumors

A clinico-pathological study

View More View Less
  • 1 Division of Neurosurgery, Departments of Pathology and Internal Medicine, The University of Texas Southwestern Medical School, Dallas, Texas
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ Eight patients with primary malignant pineal tumors have been seen at this institution over the past 6 years; six of them underwent definitive surgical exploration. Complete gross microsurgical excision of well encapsulated tumors was possible in four of these patients. In two cases of pineal germinomas, a biopsy and a subtotal resection were carried out because of the known radiosensitivity of this tumor. These six surgical patients all received postoperative craniospinal radiation and continue to do well up to 6 years postoperatively. Two nonoperative patients were initially treated at other institutions by ventriculoperitoneal shunt and radiation and were the only ones to develop metastatic disease. One patient had metastasis of her pineoblastoma to her unirradiated spinal canal and the other patient had metastasis of his germinoma to the peritoneum. The former patient was quadriplegic on admission, although her pineal tumor was no longer visible on computerized tomography (CT), and she died of pneumonia. The latter patient's tumor secreted the beta chain of human chorionic gonadotropin (HCG). This patient's massive metastatic tumor burden completely regressed as determined by body CT scan and HCG levels after four courses of chemotherapy with bleomycin, vinblastine, and cis-platinum. In 20 patients with lesions of the pineal region, craniotomy was associated with only one death (a patient with metastatic adenocarcinoma). Thus, microsurgery for pineal tumors provides either a reasonably safe potential for complete tumor extirpation and possible cure, or a tissue diagnosis which is necessary for appropriate therapeutic planning for radiotherapy and/or chemotherapy. The traditional therapeutic approach of empiric radiotherapy without a tissue diagnosis for pineal lesions may no longer be warranted.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Edward A. Neuwelt, M.D., Division of Neurosurgery, The University of Texas Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, Texas 75235.
  • 1.

    Borden S IV, , Weber AL, & Toch R, et al: Pineal germinomas. Long-term survival despite hematogenous metastases. Am J Dis Child 126:214216, 1973 Borden S IV, Weber AL, Toch R, et al: Pineal germinomas. Long-term survival despite hematogenous metastases. Am J Dis Child 126:214–216, 1973

    • Search Google Scholar
    • Export Citation
  • 2.

    Brady LW: The role of radiation therapy, in Schmidek HH (ed): Pineal Tumors. New York: Masson Publishing USA, 1977, pp 127132 Brady LW: The role of radiation therapy, in Schmidek HH (ed): Pineal Tumors. New York: Masson Publishing USA, 1977, pp 127–132

    • Search Google Scholar
    • Export Citation
  • 3.

    Camins MB, & Schlesinger EB: Treatment of tumours of the posterior part of the third ventricle and the pineal region: a long term follow-up. Acta Neurochir 40:131143, 1978 Camins MB, Schlesinger EB: Treatment of tumours of the posterior part of the third ventricle and the pineal region: a long term follow-up. Acta Neurochir 40:131–143, 1978

    • Search Google Scholar
    • Export Citation
  • 4.

    Cumins FM, , Taveras JM, & Schlesinger EB: Treatment of gliomas of the third ventricle and pinealomas. With special reference to the value of radiotherapy. Neurology 10:10311036, 1960 Cumins FM, Taveras JM, Schlesinger EB: Treatment of gliomas of the third ventricle and pinealomas. With special reference to the value of radiotherapy. Neurology 10:1031–1036, 1960

    • Search Google Scholar
    • Export Citation
  • 5.

    Dandy WE: Benign Tumors in the Third Ventricle of the Brain. Diagnosis and Treatment. Springfield, Ill: Charles C Thomas, 1933, 171 pp Dandy WE: Benign Tumors in the Third Ventricle of the Brain. Diagnosis and Treatment. Springfield, Ill: Charles C Thomas, 1933, 171 pp

    • Search Google Scholar
    • Export Citation
  • 6.

    Davidoff LM: Some considerations in the therapy of pineal tumors. Bull NY Acad Med 43:537561, 1967 Davidoff LM: Some considerations in the therapy of pineal tumors. Bull NY Acad Med 43:537–561, 1967

    • Search Google Scholar
    • Export Citation
  • 7.

    DeGirolami U, & Schmidek H: Clinicopathological study of 53 tumors of the pineal region. J Neurosurg 39:455462, 1973 DeGirolami U, Schmidek H: Clinicopathological study of 53 tumors of the pineal region. J Neurosurg 39:455–462, 1973

    • Search Google Scholar
    • Export Citation
  • 8.

    Demura R, , Demura H, & Shizume K, et al: A female case of the HCG-producing ectopic pinealoma associated with precocious puberty. Endocrinol Jpn 23:215219, 1976 Demura R, Demura H, Shizume K, et al: A female case of the HCG-producing ectopic pinealoma associated with precocious puberty. Endocrinol Jpn 23:215–219, 1976

    • Search Google Scholar
    • Export Citation
  • 9.

    de Tribolet N, & Barrelet L: Successful chemotherapy of pinealoma. Lancet 2:12281229, 1977 (Letter) de Tribolet N, Barrelet L: Successful chemotherapy of pinealoma. Lancet 2:1228–1229, 1977 (Letter)

    • Search Google Scholar
    • Export Citation
  • 10.

    Donat JF, , Okazaki H, & Gomez MR, et al: Pineal tumors. A 53-year experience. Arch Neurol 35:736740, 1978 Donat JF, Okazaki H, Gomez MR, et al: Pineal tumors. A 53-year experience. Arch Neurol 35:736–740, 1978

    • Search Google Scholar
    • Export Citation
  • 11.

    Einhorn LH: Combination chemotherapy of disseminated testicular carcinoma with cis-diammine-dichloroplatinum, vinblastine, and bleomycin (PVB): an update. Proceedings of the American Association of Clinical Oncologists, Washington, DC, April, 1978 Einhorn LH: Combination chemotherapy of disseminated testicular carcinoma with cis-diammine-dichloroplatinum, vinblastine, and bleomycin (PVB): an update. Proceedings of the American Association of Clinical Oncologists, Washington, DC, April, 1978

    • Search Google Scholar
    • Export Citation
  • 12.

    Horrax G: Treatment of tumors of the pineal body. Experience in a series of twenty-two cases. Arch Neurol Psychiatry 64:227242, 1950 Horrax G: Treatment of tumors of the pineal body. Experience in a series of twenty-two cases. Arch Neurol Psychiatry 64:227–242, 1950

    • Search Google Scholar
    • Export Citation
  • 13.

    Horrax G, & Daniels JT: The conservative treatment of pineal tumors. Surg Clin North Am 22:649659, 1942 Horrax G, Daniels JT: The conservative treatment of pineal tumors. Surg Clin North Am 22:649–659, 1942

    • Search Google Scholar
    • Export Citation
  • 14.

    Jamieson KG: Excision of pineal tumors. J Neurosurg 35:550553, 1971 Jamieson KG: Excision of pineal tumors. J Neurosurg 35:550–553, 1971

    • Search Google Scholar
    • Export Citation
  • 15.

    Jenkin RDT, , Simpson WJK, & Keen CW: Pineal and suprasellar germinomas. Results of radiation treatment. J Neurosurg 48:99107, 1978 Jenkin RDT, Simpson WJK, Keen CW: Pineal and suprasellar germinomas. Results of radiation treatment. J Neurosurg 48:99–107, 1978

    • Search Google Scholar
    • Export Citation
  • 16.

    Krabbe KH: Histologische und Embryologische Untersuchungen uber die Zirbeldruse des Mechen. Anat Hefte 54:187319, 1916 Krabbe KH: Histologische und Embryologische Untersuchungen uber die Zirbeldruse des Mechen. Anat Hefte 54:187–319, 1916

    • Search Google Scholar
    • Export Citation
  • 17.

    Kubo O, , Yamasaki N, & Kamijo Y, et al: Human chorionic gonadotropin produced by ectopic pinealoma in a girl with precocious puberty. Case report. J Neurosurg 47:101105, 1977 Kubo O, Yamasaki N, Kamijo Y, et al: Human chorionic gonadotropin produced by ectopic pinealoma in a girl with precocious puberty. Case report. J Neurosurg 47:101–105, 1977

    • Search Google Scholar
    • Export Citation
  • 18.

    Kunicki A: Operative experience in 8 cases of pineal tumor. J Neurosurg 17:815823, 1960 Kunicki A: Operative experience in 8 cases of pineal tumor. J Neurosurg 17:815–823, 1960

    • Search Google Scholar
    • Export Citation
  • 19.

    Lee SH, , Sundaresan N, & Jereb B, et al: Endodermal sinus tumor of the pineal region. Case report. Neurosurgery 3:407411, 1978 Lee SH, Sundaresan N, Jereb B, et al: Endodermal sinus tumor of the pineal region. Case report. Neurosurgery 3:407–411, 1978

    • Search Google Scholar
    • Export Citation
  • 20.

    Mincer F, , Meltzer J, & Botstein C: Pinealoma. A report of twelve irradiated cases. Cancer 37:27132718, 1976 Mincer F, Meltzer J, Botstein C: Pinealoma. A report of twelve irradiated cases. Cancer 37:2713–2718, 1976

    • Search Google Scholar
    • Export Citation
  • 21.

    Nakazato Y, , Ishida Y, & Kawabuchi J: Ganglioneuroblastic differentiation in a pineocytoma. Proceedings of the Eighth International Congress of Neuropathology. Washington, DC, September, 1978 (Abstract No. 255) Nakazato Y, Ishida Y, Kawabuchi J: Ganglioneuroblastic differentiation in a pineocytoma. Proceedings of the Eighth International Congress of Neuropathology. Washington, DC, September, 1978 (Abstract No. 255)

    • Search Google Scholar
    • Export Citation
  • 22.

    Neuwelt EA, & Clark WK: Clinical Aspects of Neuroimmunology. Baltimore: Williams and Wilkins, 1978, 277 pp Neuwelt EA, Clark WK: Clinical Aspects of Neuroimmunology. Baltimore: Williams and Wilkins, 1978, 277 pp

    • Search Google Scholar
    • Export Citation
  • 23.

    Neuwelt EA, & Smith G: Immunopathologic studies of a pineal dysgerminoma. Ann Neurol, 1979 (In press) Neuwelt EA, Smith G: Immunopathologic studies of a pineal dysgerminoma. Ann Neurol, 1979 (In press)

    • Search Google Scholar
    • Export Citation
  • 24.

    Nielsen SL, & Wilson CB: Ultrastructure of a “pineocytoma.” J Neuropathol Exp Neurol 34:148158, 1975 Nielsen SL, Wilson CB: Ultrastructure of a “pineocytoma.” J Neuropathol Exp Neurol 34:148–158, 1975

    • Search Google Scholar
    • Export Citation
  • 25.

    Olivecrona H: Acoustic tumors. J Neurosurg 26:613, 1967 Olivecrona H: Acoustic tumors. J Neurosurg 26:6–13, 1967

  • 26.

    Poppen JL, & Marino R Jr: Pinealomas and tumors of the posterior portion of the third ventricle. J Neurosurg 28:357364, 1968 Poppen JL, Marino R Jr: Pinealomas and tumors of the posterior portion of the third ventricle. J Neurosurg 28:357–364, 1968

    • Search Google Scholar
    • Export Citation
  • 27.

    Rand RW, & Lemmen LJ: Tumors of the posterior portion of the third ventricle. J Neurosurg 10:117, 1953 Rand RW, Lemmen LJ: Tumors of the posterior portion of the third ventricle. J Neurosurg 10:1–17, 1953

    • Search Google Scholar
    • Export Citation
  • 28.

    Rapoport SI: Blood Brain Barrier in Physiology and Medicine. New York: Raven Press, 1976, pp 7778 Rapoport SI: Blood Brain Barrier in Physiology and Medicine. New York: Raven Press, 1976, pp 77–78

    • Search Google Scholar
    • Export Citation
  • 29.

    Reid WS, & Clark WK: Comparison of the infratentorial and transtentorial approaches to the pineal region. Neurosurgery 3:18, 1978 Reid WS, Clark WK: Comparison of the infratentorial and transtentorial approaches to the pineal region. Neurosurgery 3:1–8, 1978

    • Search Google Scholar
    • Export Citation
  • 30.

    Ringertz N, , Nordenstam H, & Flyger G: Tumors of the pineal region. J Neuropathol Exp Neurol 13:540561, 1954 Ringertz N, Nordenstam H, Flyger G: Tumors of the pineal region. J Neuropathol Exp Neurol 13:540–561, 1954

    • Search Google Scholar
    • Export Citation
  • 31.

    Romshe CA, & Sotos JF: Intracranial human chorionic gonadotropin-secreting tumor with precocious puberty. J Pediatr 86:250252, 1975 Romshe CA, Sotos JF: Intracranial human chorionic gonadotropin-secreting tumor with precocious puberty. J Pediatr 86:250–252, 1975

    • Search Google Scholar
    • Export Citation
  • 32.

    Sakata K, , Yamada H, & Sakai N, et al: Extraneural metastasis of pineal tumor. Surg Neurol 3:4954, 1975 Sakata K, Yamada H, Sakai N, et al: Extraneural metastasis of pineal tumor. Surg Neurol 3:49–54, 1975

    • Search Google Scholar
    • Export Citation
  • 33.

    Schmidek HH (ed): Pineal Tumors. New York: Masson Publishing USA, 1977 Schmidek HH (ed): Pineal Tumors. New York: Masson Publishing USA, 1977

    • Search Google Scholar
    • Export Citation
  • 34.

    Scully RE, , Galdabini JJ, & McNeely BU (eds): Case records of the Massachusetts General Hospital, Case 38—1975. N Engl J Med 293:653660, 1975 Scully RE, Galdabini JJ, McNeely BU (eds): Case records of the Massachusetts General Hospital, Case 38—1975. N Engl J Med 293:653–660, 1975

    • Search Google Scholar
    • Export Citation
  • 35.

    Smith NJ, , El-Mahdi AM, & Constable WC: Results of irradiation of tumors in the region of the pineal body. Acta Radiol Ther Phys Biol 15:1722, 1976 Smith NJ, El-Mahdi AM, Constable WC: Results of irradiation of tumors in the region of the pineal body. Acta Radiol Ther Phys Biol 15:17–22, 1976

    • Search Google Scholar
    • Export Citation
  • 36.

    Stavrou D, , Anzil AP, & Wiedenbach W, et al: Immunofluorescence study of lymphocytic infiltration in gliomas. Identification of T-lymphocytes. J Neurol Sci 33:275282, 1977 Stavrou D, Anzil AP, Wiedenbach W, et al: Immunofluorescence study of lymphocytic infiltration in gliomas. Identification of T-lymphocytes. J Neurol Sci 33:275–282, 1977

    • Search Google Scholar
    • Export Citation
  • 37.

    Stein B: Personal communication, 1979 Stein B: Personal communication, 1979

  • 38.

    Stein BM: The infratentorial supracerebellar approach to pineal lesions. J Neurosurg 35:197202, 1971 Stein BM: The infratentorial supracerebellar approach to pineal lesions. J Neurosurg 35:197–202, 1971

    • Search Google Scholar
    • Export Citation
  • 39.

    Sung DI, , Harisliadis L, & Chang CH: Midline pineal tumors and suprasellar germinomas: highly curable by irradiation. Radiology 128:745751, 1978 Sung DI, Harisliadis L, Chang CH: Midline pineal tumors and suprasellar germinomas: highly curable by irradiation. Radiology 128:745–751, 1978

    • Search Google Scholar
    • Export Citation
  • 40.

    Suzuki J, & Iwabuchi T: Surgical removal of pineal tumors (pinealomas and teratomas). Experience in a series of 19 cases. J Neurosurg 23:565571, 1965 Suzuki J, Iwabuchi T: Surgical removal of pineal tumors (pinealomas and teratomas). Experience in a series of 19 cases. J Neurosurg 23:565–571, 1965

    • Search Google Scholar
    • Export Citation
  • 41.

    Wara WM, , Fellows CF, & Sheline GE, et al: Radiation therapy for pineal tumors and suprasellar germinomas. Radiology 124:221223, 1977 Wara WM, Fellows CF, Sheline GE, et al: Radiation therapy for pineal tumors and suprasellar germinomas. Radiology 124:221–223, 1977

    • Search Google Scholar
    • Export Citation
  • 42.

    Wurtman RJ, & Moskowitz MA: Medical progress: the pineal organ (Part I). N Engl J Med 296:13291333, 1977 Wurtman RJ, Moskowitz MA: Medical progress: the pineal organ (Part I). N Engl J Med 296:1329–1333, 1977

    • Search Google Scholar
    • Export Citation
  • 43.

    Wurtman RJ, & Moskowitz MA: Medical progress: the pineal organ (Part II). N Engl J Med 296:13831386, 1977 Wurtman RJ, Moskowitz MA: Medical progress: the pineal organ (Part II). N Engl J Med 296:1383–1386, 1977

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 292 154 12
Full Text Views 203 3 0
PDF Downloads 91 3 0
EPUB Downloads 0 0 0