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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(02): 398-401
DOI: 10.4103/ajns.AJNS_439_20
Case Report

Recurrent papillary tumor of pineal region misdiagnosed as pineocytoma 9-years ago

Nirav Mehta
Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra
,
Gaurav Gupta
Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra
,
Salman Shaikh
Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra
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Primary tumors of the pineal gland occur infrequently with a preponderance of either parenchymal tumors or germ cells tumors. Papillary tumor of the pineal region is a rare neuroepithelial lesion that arises exclusively in the pineal region. They have been designated as either Grade II or Grade III lesions as per the 2016 WHO classification of central nervous system tumors. Clinically, they usually present with obstructive hydrocephalus and visual disturbance. On imaging, these tumors are solid-cystic, heterogeneously enhancing, and show T2 hyperintensity. Pathologically, they can closely resemble a Grade I pineocytoma and immunohistochemistry is essential to differentiate the two. No definite guidelines exist to confirm the ideal protocol of treatment. Evidence regarding the role of radiation after surgery is limited to case reports and series. Adjuvant therapy is usually recommended for tumors with subtotal excision, high proliferative/mitotic index, or proven metastasis. We describe a case of a 29-year-old male with a recurrent papillary tumor of the pineal region, 9 years after primary surgery where it was misdiagnosed as a pineocytoma. The tumor was effectively controlled with surgical excision, cerebrospinal fluid diversion, and adjuvant radiation for 8 years before showing two recurrences within a span of 6 months with a rising proliferation index.

Key-words:

Cytokeratin - papillary - pineal - pineocytoma

Financial support and sponsorship

Nil.




Publication History

Received: 17 September 2020

Accepted: 13 March 2021

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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