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Palmisciano P, Ogasawara C, Nwagwu CD, Bin Alamer O, Gupta AD, Giantini-Larsen AM, Scalia G, Yu K, Umana GE, Cohen-Gadol AA, El Ahmadieh TY, Haider AS. Metastases in the Pineal Region: A Systematic Review of Clinical Features, Management Strategies, and Survival Outcomes. World Neurosurg 2022; 159:156-167.e2. [PMID: 34999267 PMCID: PMC10642482 DOI: 10.1016/j.wneu.2022.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/01/2022] [Accepted: 01/03/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pineal region metastases are rare but often cause severe neurologic deficits. Surgical resection and chemoradiotherapy can provide therapeutic benefit. We investigated the literature to analyze clinical characteristics, management strategies, and survival of adult patients with pineal region metastases. METHODS PubMed, Embase, Scopus, and Cochrane were searched following the PRISMA guidelines, including studies reporting clinical outcomes of patients with pineal region metastases. Clinical presentation, management, and survival were reviewed. RESULTS We included 31 studies comprising 47 patients. Lung cancer (29.8%) and carcinomas of unknown origin (14.9%) were the most frequent primary tumors. In 48.9% of patients, symptomatic pineal metastases preceded primary tumor diagnosis. Headache (67.4%) and confusion (46.5%) were the most common symptoms. Parinaud syndrome (46.5%) and hydrocephalus (87.2%) were noted. Biopsy (65.9%) was preferred over resection (34.1%), and shunting strategies used were endoscopic third ventriculostomy (43.9%) and ventriculoperitoneal (26.8%). Eleven patients (32.3%) received adjuvant chemotherapy and 32 (68%) received radiotherapy. Posttreatment improvement in symptoms (56.6%) and hydrocephalus (80.5%) were noted. In patients who received adjuvant chemotherapy/radiotherapy, significant improvement in posttreatment performance status occurred with both biopsy (P < 0.001) and resection (P = 0.007). No survival differences were reported between surgery and biopsy (P = 0.912) or between complete and partial resection (P = 0.220). Overall survival was neither influenced by surgical approach (P = 0.157) nor by shunting strategy (P = 0.822). Mean follow-up was 8 months and median overall survival 3 months. Only 2 cases (4.8%) of pineal metastasis showed recurrence. CONCLUSIONS Pineal region metastases carry significant morbidity. Biopsy or surgical resection, combined with adjuvant chemotherapy/radiotherapy and/or shunting, may significantly improve performance status.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy.
| | - Christian Ogasawara
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
| | | | - Othman Bin Alamer
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Aditya D Gupta
- Texas A&M University College of Medicine, Houston, Texas, USA
| | - Alexandra M Giantini-Larsen
- Department of Neurosurgery and Brain Metastases Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital of National Importance "Garibaldi" Catania, Italy
| | - Kenny Yu
- Department of Neurosurgery and Brain Metastases Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Aaron A Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tarek Y El Ahmadieh
- Department of Neurosurgery and Brain Metastases Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ali S Haider
- Texas A&M University College of Medicine, Houston, Texas, USA; Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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Simultaneous single-trajectory endoscopic biopsy and third ventriculostomy in pediatric pineal region tumors. Acta Neurol Belg 2021; 121:1535-1542. [PMID: 32506355 DOI: 10.1007/s13760-020-01387-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
Pineal region tumors have different pathological tumors and their optimal management remains controversial. Advancements in neuroendoscopy have led to the ability to simultaneously treat the hydrocephalus and obtain a tissue diagnosis. A retrospective review of 34 patients with pineal region tumors in Beijing Tiantan hospital from the year 2016 to 2018 was undertaken. A single bur hole for both procedures was used successfully in all patients. Once pathologic diagnosis is made, the subsequent management of different tumors is dependent on response to therapy, the tumor markers and original pathology. Follow-up period was 4-26 months. All 34 cases presented with hydrocephalus and increased intracranial pressure manifestations. Elevated blood tumor markers were found in seven cases. The neuroendoscopic biopsy was diagnostic in 32 samples (94.1%) and nondiagnostic (gliosis) in two patients. 21 cases were germinomas, five cases were tectal astrocytomas, two cases were pineoblastomas, two cases were non-germinomatous germ-cell tumours (NG-GCTs) and 1 case immature teratoma and glioblastoma respectively. During the follow-up period, all germinomas but one case with elevated blood α-fetoprotein received craniotomy with a final diagnosis of NG-GCT received radiotherapy and chemotherapy. Four tectal astocytomas, two pineoblastomas and two NG-GCTs received subsequent open surgery due to progressive development, the pathological data was concordant with the initial endoscopic biopsy sample. An additional VP shunt was inserted in one tectal astrocytoma who have hydrocephalus after craniotomy. Except for 18 cases of transient fever and a case with intratumoral hemorrhage, there was no other significant complications, cognitive disorder and no death. The simultaneous single-trajectory endoscopic technique permits not only to control hydrocephalus but also to obtain histological diagnosis with a low incidence of complication and higher safety. Providing meaningful pathological data, endoscopic biopsies could lead to an appropriate management decision. Especially, it is favored as an early step in the management of patients with marker-negative tumors.
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Alolyani AM, Al Luwimi I, Ammar A. An Elderly Man Suffers a Renal Cell Carcinoma Metastasis in the Pineal Gland: Lessons Learned and Ethical Considerations. Cureus 2021; 13:e14771. [PMID: 34094736 PMCID: PMC8164822 DOI: 10.7759/cureus.14771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Metastases to the pineal gland are rare and reported cases have consisted mainly of lung and gastrointestinal primary malignancies. Here we report the third case in the literature of pineal gland metastasis from renal cell carcinoma. A 69-year-old man, status post excision of right renal cell carcinoma 20 years ago, presented with a one-month history of urinary incontinence. Images revealed a solitary mass in the pineal region with obstructive hydrocephalus. Endoscopic third ventriculostomy (ETV) and biopsy of pineal mass were performed. The histological diagnosis of the biopsy was inconclusive. The patient was scheduled for a follow-up and readmission for a repeat biopsy, however, was lost to follow-up. No attempts were made by the hospital team or patient relations department to contact him. Eventually, the patient presented after 18 months to the emergency room (ER) with confusion, forgetfulness, gait disturbance, weakness of lower extremities, and vision loss due to enlarged pineal mass. Another ETV and biopsy were performed. The histological findings were compatible with metastasis from renal cell carcinoma. The patient died after three months due to rapid general deterioration in his condition. The lessons that have been learned from this case are: 1) Metastatic tumor should be considered in the differential diagnosis of pineal region tumors, particularly in elderly patients and with a known history of malignancy; 2) If the first biopsy is inconclusive, a rapid plan and a strict follow-up for a repeat biopsy should be made; 3) Elderly patients should have special care; they should be well informed about their condition and should be contacted regularly to ensure that they receive the optimal management plan.
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Affiliation(s)
- Amira M Alolyani
- Department of Neurosurgery, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, SAU
| | - Ibrahim Al Luwimi
- Department of Neurosurgery, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, SAU
| | - Ahmed Ammar
- Department of Neurosurgery, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, SAU
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Ji J, Gu C, Zhang M, Zhang H, Wang H, Qu Y, Ren M, Ning W, Yu C. Pineal region metastasis with intraventricular seeding: A case report and literature review. Medicine (Baltimore) 2019; 98:e16652. [PMID: 31441839 PMCID: PMC6716749 DOI: 10.1097/md.0000000000016652] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Tumors of the pineal region are rare, and metastatic carcinoma occurring in the pineal region is extremely rare. No previous reports have described pineal region metastasis with intraventricular seeding. PATIENT CONCERNS We report a case of a 51-year-old woman presented with a 1-week history of severe headache, nausea, and vomiting. Imaging examination revealed 2 lesions in the pineal region and the right lateral ventricle. DIAGNOSIS Pinealocytoma or germinoma was considered as the preoperative diagnosis. The postoperative pathological diagnosis was small cell neuroendocrine carcinoma. After bronchoscopic biopsy, small cell lung cancer was confirmed. INTERVENTIONS A right frontal craniotomy and a translateral ventricle approach were performed to remove 2 lesions completely. And regular radiotherapy and chemotherapy were initiated after surgery. OUTCOMES The patient was discharged from the hospital 2 weeks after operation and went to another cancer hospital for bronchoscopic biopsy, radiotherapy, and chemotherapy. Finally, the patient died 2 years after surgical treatment. CONCLUSION Metastatic tumors of the pineal region are very rare. For patients with pineal lesions, a diagnosis of a metastatic tumor should be considered. Retrograde cerebrospinal fluid circulation might be the reason for a secondary metastasis.
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Endoscopic Transseptal Transcaval Interforniceal Approach to the Posterior Third Ventricle in the Presence of Cavum Septum Pellucidum. World Neurosurg 2017; 103:768-771. [DOI: 10.1016/j.wneu.2017.04.116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 11/19/2022]
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Roth J, Constantini S. Combined rigid and flexible endoscopy for tumors in the posterior third ventricle. J Neurosurg 2015; 122:1341-6. [PMID: 25816082 DOI: 10.3171/2014.9.jns141397] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Tumors leading to occlusion of the sylvian aqueduct include those of pineal, thalamic, and tectal origins. These tumors cause obstructive hydrocephalus and thus necessitate a CSF diversion procedure such as an endoscopic third ventriculostomy (ETV), often coupled with an endoscopic biopsy (EBX). Lesions located posterior to the massa intermedia pose a technical challenge, as the use of a rigid endoscope for performing both an ETV and EBX is limited. The authors describe their experience using a combined rigid and flexible endoscopic procedure through a single bur hole for both procedures in patients with posterior third ventricular tumors. METHODS Since January 2012, patients with posterior third ventricular tumors causing hydrocephalus underwent dual ETV and EBX procedures using the combined rigid-flexible endoscopic technique. Following institutional review board approval, data from clinical, radiological, surgical, and pathological records were retrospectively collected. RESULTS Six patients 3.5-53 years of age were included. Lesion locations included pineal (n = 3), fourth ventricle (n = 1), aqueduct (n = 1), and tectum (n = 1). The ETV and EBX were successful in all cases. Pathologies included pilocytic astrocytoma, pineoblastoma, ependymoma Grade II, germinoma, low-grade glioneural tumor, and atypical choroid plexus papilloma. One patient experienced an immediate postoperative intraventricular hemorrhage necessitating evacuation of the clots and resection of the tumor, eventually leading to the patient's death. CONCLUSIONS The authors recommend using a combined rigid-flexible endoscope for endoscopic third ventriculostomy and biopsy to approach posterior third ventricular tumors (behind the massa intermedia). This technique overcomes the limitations of using a rigid endoscope by reaching 2 distant regions.
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Affiliation(s)
- Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Matsuda K, Sakurada K, Kokubo Y, Sato S, Nakazato Y, Kayama T. An esophageal neuroendocrine tumor metastatic to the pineal region. Brain Tumor Pathol 2014; 31:192-7. [DOI: 10.1007/s10014-014-0178-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/22/2014] [Indexed: 11/30/2022]
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Are stereotactic sample biopsies still of value in the modern management of pineal region tumours? Lessons from a single-department, retrospective series. Acta Neurochir (Wien) 2011; 153:1111-21; discussion 1121-2. [PMID: 21331478 DOI: 10.1007/s00701-010-0936-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Recent improvements in imaging-based diagnosis, the broader application of neuroendoscopic techniques and advances in open surgery techniques mean that the need for stereotactic biopsies in the management of pineal region tumours must be reevaluated. The primary aim of this retrospective study was to establish whether stereotactic biopsy is still of value in the modern management of pineal region tumours. METHODS From 1985 to 2009, 88 consecutive patients underwent a stereotactic biopsy in our institution (51 males and 37 females; median age at presentation 30; range 2-74). RESULTS Accurate tissue diagnoses were obtained in all but one case (i.e. 99%). In one case (1%), three distinct stereotactic procedures were necessary to obtain a tissue diagnosis. There was no mortality or permanent morbidity associated with stereotactic biopsy. One patient (1%) presented an intra-parenchymal hematoma but no related clinical symptoms. Five patients (6%) presented transient morbidity, which lasted for between 2 days and 3 weeks after the biopsy. CONCLUSIONS To guide subsequent treatment, we believe that histological diagnosis is paramount. Stereotactic biopsies are currently the safest and the most efficient way of obtaining this essential information. Recent improvements in stereotactic technology (particularly robotic techniques) appear to be very valuable, with almost no permanent morbidity or mortality risk and no decrease in the accuracy rate. In our opinion, other available neurosurgical techniques (such as endoscopic neurosurgery, stereotactic neurosurgery and open microsurgery) are complementary and not competitive.
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Levidou G, Korkolopoulou P, Agrogiannis G, Paidakakos N, Bouramas D, Patsouris E. Low-grade oligodendroglioma of the pineal gland: a case report and review of the literature. Diagn Pathol 2010; 5:59. [PMID: 20849631 PMCID: PMC2949720 DOI: 10.1186/1746-1596-5-59] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Accepted: 09/17/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gliomas are a very rare subtype of pineal region tumours, whereas oligodendrogliomas of the pineal region are exceedingly rare, since there have been only 3 cases of anaplastic oligodedrogliomas reported this far. METHODS-RESULTS We present a case of a low-grade oligodendroglioma arising in the pineal gland of a 37 year-old woman. The patient presented with diplopia associated with a cystic pineal region mass demonstrated on MRI. Total resection was performed and histological examination showed that the cystic wall consisted of tumour cells with a central nucleus a perinuclear halo and minimal pleomorphism. Immnunohistochemical analysis showed that these cells were diffusely positive for CD57, and negative for GFAP, CD10, CD99, cytokeratins, neurofilaments and synaptophysin. FISH analysis was performed in a small number of neoplastic cells, which were not exhausted after immunohistochemistry and did not reveal deletion of 1p and 19q chromosome arms. However, the diagnosis of a low grade oligodendroglioma of the pineal gland was assigned. CONCLUSION Although the spectrum of tumours arising in the pineal gland is broad, the reports of oligodendrogliomas confined to this location are exceedingly rare, and to the best of our knowledge there is no report of a low-grade oligodendroglioma. However, they should be added in the long list of tumours arising in the pineal gland.
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Affiliation(s)
- Georgia Levidou
- National and Kapodistrian University of Athens, Department of Pathology, Athens, 11527, Greece
| | - Penelope Korkolopoulou
- National and Kapodistrian University of Athens, Department of Pathology, Athens, 11527, Greece
| | - George Agrogiannis
- National and Kapodistrian University of Athens, Department of Pathology, Athens, 11527, Greece
| | | | - Dimos Bouramas
- Department of Neurosurgery, Athens Naval Hospital, Athens 11521, Greece
| | - Efstratios Patsouris
- National and Kapodistrian University of Athens, Department of Pathology, Athens, 11527, Greece
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Hanada T, Oyoshi T, Hirano H, Arita K. Metastatic pineal tumors treated by neuroendoscopic surgery--two case reports. Neurol Med Chir (Tokyo) 2010; 50:232-6. [PMID: 20339275 DOI: 10.2176/nmc.50.232] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two patients presented with metastatic pineal tumors. A 69-year-old man had gait disturbance, dementia, and urinary incontinence but no history of previous malignancy. Magnetic resonance imaging of the brain revealed a 23-mm tumor in the pineal region and obstructive hydrocephalus. A 37-year-old man had been treated for thyroid cancer. He presented with vomiting and consciousness disturbance. Brain magnetic resonance imaging revealed a 28-mm pineal tumor associated with intratumoral hemorrhage and accompanying obstructive hydrocephalus. Both patients underwent neuroendoscopic biopsy and third ventriculostomy through the foramen of Monro, resulting in reliable histological diagnoses and subsidence of hydrocephalus.
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Affiliation(s)
- Tomoko Hanada
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
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Naugler C, Xu Z. Pancreatic adenocarcinoma metastatic to the pineal gland. J Clin Neurosci 2008; 15:1284-6. [DOI: 10.1016/j.jocn.2007.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 08/17/2007] [Accepted: 08/21/2007] [Indexed: 11/29/2022]
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