|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 1 | Page : 107-108
Importance of correct histopathological assessment of pineal region tumors
Pallavi J Agrawal, Satish Naware, Amit T Kharat
Department of Radiodiagnosis, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, India
|Date of Web Publication||10-Dec-2013|
Pallavi J Agrawal
Department of Radiodiagnosis, Padmashree Dr. D.Y. Patil Medical College, Sant Tukaram Nagar, Pimpri
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agrawal PJ, Naware S, Kharat AT. Importance of correct histopathological assessment of pineal region tumors. Med J DY Patil Univ 2014;7:107-8
In July-Sept 2013 issue of Medical journal of Dr. D. Patil University, Meena Patil et al.  published a case report titled ''Papillary tumor of pineal region: A rare entity,'' elaborating its histopathological aspect. This letter stresses the importance of precise histopathological assessment of pineal region tumors (PRTs) with the help of an interesting case of a similar pineal gland tumor, which was referred to our department and gives an overview of PRTs for reader's benefit.
A 30-year-old female was referred to our department with complaints of severe backache and inability to walk since 1 year. Four years ago, she was operated for a PRTin a reputed institute of Pune. The histopathology report for the operated specimen was offered as pineocytoma.MRI done at our institute revealed diffuse leptomeningeal seeding with CSF drop metastases to the spinal cord. Considering the mismatch between these imaging findings and prior histopathology report, the old histopathological slides were reviewed to offer a diagnosis of pineal parenchymal tumor of intermediate origin (PPTID) rather than pineocytoma.
Pineocytoma being a WHO grade I tumor is rare to present as a recurrence with leptomeningeal spread and drop metastases to spine. There is a likelihood that the original tumor had regions of PPTID which probably missed the scrutiny, suggesting that it was a high grade tumor to begin with. The other possibility is of dedifferentiation of pineocytoma into a more aggressive transitional tumor i.e., PPTID, over a period of time, which is rare, but must be borne in mind before coming to a final diagnosis and establishing treatment protocol. 
Pineal region tumors (PRTs) include germ cell tumors (GCTs) that are the most common PRTs followed by pineal parenchymal tumors and the rarer, miscellaneous group that includes pineal papillary tumors.Pineal parenchymal tumors include, in the decreasing order of frequency, the low-grade pineocytoma, highly malignant pineoblastoma and the intermediate-grade PPTID.
PRTs have no pathognomonic radiological features, though certain findings can provide clues to their correct characterization which includes signal intensity (iso- to hyperintense to gray matter on T1- and T2-weighted images in a germinoma and pineoblastoma, T1 hyperintensity of papillary tumor), central engulfed calcification (GCT), peripheral burst calcification (pineoblastoma).
GCTs and pineoblastomas have a propensity for CSF spread and local recurrence, pineocytoma and PPTID rarely show CSF seeding, frequency being higher in the latter, while papillary tumors have a reported tendency to local recurrence of upto 51%.
Precise histopathological assessment of these tumors is the first step in management of PRTs, and hence must be done carefully for appropriate management, which can eliminate the risk of tumor progress or its expansion.  The case presented from our department aptly brings out this fact.
This letter underlines the importance of the following aspects in respect of pineal region tumors:
First, the histopathological characterization of pineal parenchymal tumors is not straightforward. Second, long term follow up of patients with pineal tumors is necessary following treatment; considering their variable behavior.
| References|| |
|1.||Patil M, Karandikar M. Papillary tumor of pineal region: A rare entity. Med J DY Patil Univ 2013;6:302-4. |
|2.||Gomez C, Wu J, Pope W, Vinters H, Desalles A, Selch M. Pineocytoma with diffuse dissemination to the leptomeninges. Rare Tumors 2011;3:e53. |
|3.||Fischer B, Palkovic S, Wassmann H. Treatment strategy of pineal tumors in consideration of their pathomorphology. Bratisl Lek Listy 2004;105:95-100. |