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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    • "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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    • "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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    • "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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