Pineal gland lesions: A cytopathologic study of 20 specimens

Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.
Cancer (Impact Factor: 4.89). 05/2005; 105(2):80-6. DOI: 10.1002/cncr.20849
Source: PubMed


Pineal gland lesions are rare, with only a few cytologic descriptions occurring in the literature, according to the authors' knowledge. The current article describes the cytopathologic characteristics of 20 such lesions with discussion of differential diagnoses.
Cytologic material was obtained either by fine-needle aspiration biopsy (FNAB) under stearotactic radiologic guidance or by touch imprinting (TI) at the time of frozen sectioning. The 20 specimens include pineoblastoma (five specimens), pineocytoma (four specimens), astrocytoma (three specimens), germ cell tumor (three specimens), meningioma (one specimen), epidermoid cyst (three specimens), and pineal cyst (one specimen). Smears were stained with Diff-Quik and with Papanicolaou and hematoxylin and eosin stains. In selected specimens, immunoperoxidase (IPOX) stains were performed on cell block sections using synaptophysin, neuron-specific enolase, placental alkaline phosphatase, glial fibrillary acidic protein, leukocyte common antigen, cytokeratins, and human chorionic gonadotropin antibodies.
Several cytomorphologic characteristics unique to each lesional category with occasional overlapping features were observed. The unique features included the following: small, hyperchromatic, round to oval cells with frequent rosetting (pineocytoma), with a few specimens in addition showing hypercellularity, crowding, mitoses, and necrosis (pineoblastoma); pleomorphic round cells in a fibrillary background (astrocytoma); large polygonal cells with prominent nucleoli and clear cytoplasm (germ cell tumor); spindled fibroblastic cells (meningioma); anucleate squames and mature squamous cells (epidermoid cyst); and small uniform polygonal cells (pineal cyst). When necessary, IPOX studies supported the morphologic diagnoses.
FNAB and TI cytology were found to provide a rapid and reliable diagnosis of pineal lesions. This is particularly important when dealing with minute amounts of tissue material. Both techniques appeared to provide equally good cytomorphology on smears. IPOX studies played an important complementary role in difficult cases when performed on cell blocks.

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Available from: Yener S Erozan, Dec 11, 2014
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    • "In adults, the most common sites, in order of frequency, are mediastinum, retroperitoneum, and pineal gland and suprasellar regions [1] [2] [3]. GCTs account for approximately 15% of mediastinal tumors in adult. "
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    ABSTRACT: Germ cell tumor with somatic malignant transformation is an uncommon phenomenon occurring about 7% of all mediastinal teratomas. Among all transformed component, sarcoma appears to be the most frequent histology, followed by primitive neuroectodermal tumor (PNET) and adenocarcinoma. To our knowledge, there were 3 cases of colonic-type adenocarcinoma arising in a primary teratoma have been reported to date. However, none of them received chemotherapy directed to transformed histology given localized disease at presentation. We, therefore, report here the first case of patient who achieved good response from chemotherapy directed to transformed histology, which confirms the importance of chemotherapy regimen used.
    Case Reports in Oncological Medicine 09/2012; 2012:729278. DOI:10.1155/2012/729278
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    • "Most tumours arising in the pineal region reportedly result from malignant transformation of the pineal parenchymal cells, the surrounding stromal or so called "interstitial" cells or the cells comprising the adjacent tissues [3], a fact which along with the presence of fibrillary astrocytes and oligodendrocytes in the pineal parenchyma, supports the concept that gliomas restricted in the pineal region presumably originate from pineal glial cells. However, the few gliomas reported in the literature usually involved the adjacent brain tissues as well, so that it is not very clear whether the resected tumour arose primarily from the pineal gland or involved it secondarily [3,7-9,22]. In our case the conclusion that the tumour arose from the pineal gland was based on postoperative MRI, intraoperative inspection, and the excellent postoperative course of the patient after complete excision of the epiphesial lesion. "
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    ABSTRACT: 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. 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. 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.
    Diagnostic Pathology 09/2010; 5(1):59. DOI:10.1186/1746-1596-5-59 · 2.60 Impact Factor
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    • "These tumors exhibit a spectrum of clinical aggressiveness that include pineocytomas, which are low-grade well-differentiated and indolent tumors often with large pineocytomatous rosettes; pineoblastomas, which are high-grade poorly-differentiated aggressive embryonal tumors with dense sheets of poorly differentiated small cells and pineal parenchymal tumors of intermediate differentiation (PPTID), which have an intermediate grade and prognosis[2]–[7]. The appropriate pathologic classification and grading of tumors of the pineal region is essential for determining clinical management and prognosis[8], however, the diagnostic evaluation is often difficult due to the inherently small size of the biopsies for diagnosis and the wide array of tumor types that can involve the pineal gland[3], [9]. The most common tumors entering the differential diagnosis are CNS germ cell tumors, primitive neuroectodermal tumors, gliomas, atypical teratoid/rhabdoid tumors and anaplastic ependymoma[2], [6], [10]. "
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    ABSTRACT: CRX is a homeobox transcription factor whose expression and function is critical to maintain retinal and pineal lineage cells and their progenitors. To determine the biologic and diagnostic potential of CRX in human tumors of the retina and pineal, we examined its expression in multiple settings. Using situ hybridization and immunohistochemistry we show that Crx RNA and protein expression are exquisitely lineage restricted to retinal and pineal cells during normal mouse and human development. Gene expression profiling analysis of a wide range of human cancers and cancer cell lines also supports that CRX RNA is highly lineage restricted in cancer. Immunohistochemical analysis of 22 retinoblastomas and 13 pineal parenchymal tumors demonstrated strong expression of CRX in over 95% of these tumors. Importantly, CRX was not detected in the majority of tumors considered in the differential diagnosis of pineal region tumors (n = 78). The notable exception was medulloblastoma, 40% of which exhibited CRX expression in a heterogeneous pattern readily distinguished from that seen in retino-pineal tumors. These findings describe new potential roles for CRX in human cancers and highlight the general utility of lineage restricted transcription factors in cancer biology. They also identify CRX as a sensitive and specific clinical marker and a potential lineage dependent therapeutic target in retinoblastoma and pineoblastoma.
    PLoS ONE 11/2009; 4(11):e7932. DOI:10.1371/journal.pone.0007932 · 3.23 Impact Factor
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