We report a case of papillary tumor in the pineal region.The imaging findings mainly included:(1)slight high density on CT images;(2)short T1 signal,cystic changes,and evident enhancement on magnetic resonance imaging.
Brain Neoplasms ; Humans ; Magnetic Resonance Imaging ; Pineal Gland/diagnostic imaging* ; Pinealoma/diagnostic imaging*

OBJECTIVETo evaluate the three-dimensional CT angiography (3D-CTA) assisted suboccipital transtentorial approach (Poppen's approach) in the treatment of pineal region meningioma.

METHODSDuring the period of January 2005 to January 2010, 8 patients with pineal region meningioma were successfully treated using Poppen's approach through cerebral falx and tentorium. There were three male patients and five female patients were aged at a range of 41 - 64 years, average age was (54 ± 10) years. According to the Karnofsky performance scale (KPS), 5 patients' KPS scores were more than or equal to 80 and 3 were less than 80. MRI was used for the diagnosis of meningioma. 3D-CTA was applied to detect meningioma staining and blood supply. For preoperative concurrent hydrocephalus, follow-up observations were given. If hydrocephalus didn't get better or even became worse, ventriculoperitoneal shunt should be considered.

RESULTSAll the surgery were successfully performed, and venous complexes (VC) were well protected according to the CTA images. Out of the eight cases whose meningiomas were removed, one patient had got postoperative intracranial infection and recovered after given antibiotics. All patients were followed up for a period of 6 - 24 months. Preoperative concurrent hydrocephalus in 7 patients were improved. However, there was an aggravation of the hydrocephalus in one patient who was treated with ventriculoperitoneal shunt. The MRIs which were performed at the end of follow-up period, showed no recurrence of meningiomas, and preoperative symptoms were improved to varying degrees, 7 patients' KPS scores were more than or equal to 80 and 1 was less than 80. A χ(2) test was used to analyze and to make comparisons between preoperative and postoperative KPS. The significance was indicated (χ(2) = 1.33, P < 0.05).

CONCLUSIONSFor meningiomas in the pineal region, 3D-CTA is of great clinical value to distinguish the anatomic relationship among the meningioma, blood supply and VC. This case study has strongly supported using Poppen's approach assisted by 3D-CTA to proceed with the operation.

Adult ; Cerebral Angiography ; methods ; Female ; Follow-Up Studies ; Humans ; Imaging, Three-Dimensional ; Male ; Meningeal Neoplasms ; diagnostic imaging ; surgery ; Meningioma ; diagnostic imaging ; surgery ; Middle Aged ; Pineal Gland ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo study the clinicopathologic features of papillary tumor of the pineal region (PTPR).

METHODThree hundred and eighty six cases of pineal region and posterior third ventricle tumors, two newborn and two adult pineal glands were analyzed by HE, PAS and immunohistochemistry of 16 antibodies (EnVision method).

RESULTSFive cases of PTPR were diagnosed with mixed papillary features and densely cellular areas, and included one recurrent case. In the papillary areas, the vessels were lined by one or several layers of cuboidal/columnar cells; the vessel wall was hyalinized. In the densely cellular areas, sheets or nests of tumor cells were seen. The tumor cells of these five cases were immunoreactive to CK, CK8/18, synaptophysin, MAP2, nestin, S-100, and vimentin. Four cases were immunoreactive to NSE and CgA; and 2 cases were immunoreactive to NF. All five cases were negative for EMA, CK5/6, CEA, and NeuN. Ki-67 labeling index ranged from 1% to 6%.Three patients were alive, and the recurrent one died.

CONCLUSIONSPTPR occurs in patients with over a wide age range, from children to adults, and is more commonly found in male than female. PTPR is composed of both papillary and solid areas, characterized by epithelial cytology, and needs to be differentiated from ependymoma. PTPR may originate from the specialized ependymocytes of the subcommissural organ. The prognostic factors are early diagnosis, complete surgical resection and radiotherapy.

Adolescent ; Adult ; Brain Neoplasms ; diagnostic imaging ; metabolism ; pathology ; radiotherapy ; surgery ; Carcinoma, Papillary ; diagnostic imaging ; metabolism ; pathology ; radiotherapy ; surgery ; Child ; Diagnosis, Differential ; Ependymoma ; metabolism ; pathology ; Female ; Humans ; Immunohistochemistry ; Keratin-18 ; metabolism ; Keratin-8 ; metabolism ; Keratins ; metabolism ; Male ; Microtubule-Associated Proteins ; metabolism ; Nestin ; metabolism ; Pineal Gland ; Pinealoma ; metabolism ; pathology ; S100 Proteins ; metabolism ; Synaptophysin ; metabolism ; Tomography, X-Ray Computed ; Vimentin ; metabolism ; Young Adult