Pineal gland lesions: a cytopathologic study of 20 specimens.

Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.
Cancer (Impact Factor: 4.9). 05/2005; 105(2):80-6. DOI: 10.1002/cncr.20849
Source: PubMed

ABSTRACT 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.

  • [Show abstract] [Hide abstract]
    ABSTRACT: As primary pineal lesions are extremely rare, many surgical pathologists are unfamiliar with normal pineal cytologic features. We describe cytologic features of the normal pineal gland in patients of varying ages and identify common diagnostic pitfalls. We performed a retrospective review of pineal gland biopsies performed at our institution, where approximately 30,000 surgical specimens are accessioned yearly, for the last 23 years. Only two pineal gland biopsies were found. Although both cases were initially diagnosed as low-grade gliomas on frozen section, the final diagnosis was benign pineal tissue based on light microscopy and immunohistochemistry results. Additionally, we performed squash preparations of five normal pineal gland autopsy specimens with Papanicolaou and Diff-Quik® (Dade Behring, Newark, DE) stains. Infant preparations were highly cellular smears composed of numerous, uniform, single cells with indistinct cytoplasm, small round-to-oval nuclei, fine chromatin, and absent nucleoli and calcifications. The vague microfollicular pattern mimicked a pineocytoma and the fine fibrillary background mimicked a glial neoplasm. Young adult smears were similar; however, microcalcifications were present with fewer background single cells. Older patients had much less cellular smears composed of small clusters of cells with fusiform-to-spindle nuclei, a fine chromatin pattern, and indistinct cytoplasmic borders. There were fewer background single cells and more microcalcifications. The cytologic features of the native pineal gland vary with age. Normal pineal tissue can be confused with a pineocytoma or low-grade glioma. Familiarity with normal pineal gland cytological features will help to avoid a potential misdiagnosis. Diagn. Cytopathol. 2014. © 2014 Wiley Periodicals, Inc.
    Diagnostic Cytopathology 11/2014; 42(11). DOI:10.1002/dc.23156 · 1.52 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although several series of pineal region tumors are available, the issue of pineal gliomas has been scarcely faced in the literature. Gliomas are usually included in largest series of pineal neoplasms. Therefore, whether pineal gliomas share the biological behavior of either hemispheric gliomas or other midline lesions is not yet defined. The aim of this retrospective study is to analyze long-term morbidity and mortality of these lesions. In English published literature gliomas account for about 14-22 % of all pineal region tumors. Most of these tumors are pilocytic astrocytomas, while glioblastoma multiforme is rare. We retrospectively analyzed all pineal region tumors operated on in our department in the last 28 years, and identified eight pineal astrocytomas, accounting for 14.03 % of all pineal tumors. The series includes four pilocytic astrocytomas, two grade II diffuse astrocytomas, and two anaplastic astrocytomas. A comprehensive review of the available literature data shows that the mean survival time of WHO grade II gliomas is shorter when tumor grows in the pineal region than for hemispheric locations, although the limited amount of available data prevents a rigorous statistical analysis. This difference might be due to the peculiar infiltrating behavior of pineal tumors, which often can't be satisfactorily resected from vital structures.
    Journal of Neuro-Oncology 07/2013; 115(1). DOI:10.1007/s11060-013-1200-9 · 2.79 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Extragonadal germinal cell tumors located in the brain are rare and are most commonly found in the pineal and suprasellar region. Germinoma is the most frequent intracranial one. It has a good prognosis and response to treatment and a high incidence among Chinese and Japanese. When in the typical location, pineal and sellar, they display characteristic features on CT and MRI. Diagnosis confirmation requires histologic study in which they show a diffuse pattern with epithelial-type tumoral cellularity associated to a well differentiated lymphoid infiltrate. Some tumours express granulomatous reaction mimicking TBC and sarcoidosis and other have small cells that have to be differentiated with lymphomas and primitive neuroectodermic tumors. Immunohistochemical studies in germinomas show positive cytoplasmic reaction to Placental Alkaline Phosphatase (PLAP) in epithelial cells and CD3 positive in lymphoid cells. This article reports two cases of typically located intracranial germinoma in male adolescents with characteristic symptoms related to the compromise of the suprasellar and pineal region, extension to neighbouring organs and repercussion in visual, auditive and motor functions. The CT and MRI show the lesions with good definition, location, extension and the histological study reveals the presence of a biphasic histologic component: Diffuse and poorly cohesive epithelial of eosinophilic abundant cytoplasm and hyperchromic nuclei, and fine vascularized connective septa infiltrated by mature lymphoid cells organized around the capillaries. The PAS dye shows fine positivity in the cytoplasm of the epithelial cells and the immunohistochemistry for Carcinoembryonic antigen (CEA) is negative; there is also cytoplasmic positivity for PLAP in epithelial cells an CD3 positivity for septal lymphoid cells, which confirms the diagnosis of cerebral germinoma.
    10/2007; 40(4). DOI:10.1016/S1699-8855(07)70084-3

Full-text (2 Sources)

Available from
Dec 11, 2014