scholarly journals Case Report: Metastatic Bronchopulmonary Carcinoid Tumor to the Pineal Region

2021 ◽  
Vol 12 ◽  
Author(s):  
Joshua A. Cuoco ◽  
Michael W. Kortz ◽  
Edwin McCray ◽  
Evin L. Guilliams ◽  
Christopher M. Busch ◽  
...  
Keyword(s):  
Pineal Gland ◽  
Neuroendocrine Tumor ◽  
Carcinoid Tumor ◽  
Neuroendocrine Tumors ◽  
Ductal Carcinoma ◽  
Tumor Resection ◽  
Pineal Region ◽  
Neurological Deficits ◽  
Pineal Region Tumors ◽  
Bronchopulmonary Carcinoid

Intracranial spread of a systemic malignancy is common in advanced staged cancers; however, metastasis specifically to the pineal gland is a relatively rare occurrence. A number of primary lesions have been reported to metastasize to the pineal gland, the most common of which is lung. However, metastasis of a bronchial neuroendocrine tumor to the pineal gland is a seldom-reported entity. Here, we present a 53-year-old female who presented with worsening headaches and drowsiness. MRI brain revealed a heterogeneously enhancing partially cystic mass in the pineal region. The patient had an extensive oncologic history consisting of remote stage IIA invasive breast ductal carcinoma as well as a more recently diagnosed atypical bronchopulmonary neuroendocrine tumor with lymph node metastases. She underwent microsurgical volumetric resection of the large pineal mass and a gross total removal of the tumor was achieved. Histopathology confirmed a metastatic tumor of neuroendocrine origin and the immunohistochemical profile was identical to the primary bronchopulmonary carcinoid tumor. Eight weeks after surgery, she underwent stereotactic radiosurgical treatment to the resection cavity. At 1-year follow-up, the patient remains clinically stable without any new focal neurological deficits and without any evidence of residual or recurrent disease on postoperative MRI. Metastatic neuroendocrine tumors should be considered in the differential diagnosis of pineal region tumors and aggressive surgical resection should be considered in selected patients. Gross total tumor resection may afford excellent local disease control. We discuss the relevant literature on neuroendocrine tumors and current treatment strategies for intracranial metastases of neuroendocrine origin.

Serum Melatonin Levels: A New Neurodiagnostic Tool in Pineal Region Tumors?

Neurosurgery ◽  
1987 ◽  
Vol 21 (6) ◽  
pp. 817-824 ◽  
Author(s):  
Peter Vorkapic ◽  
Franz Waldhauser ◽  
Robert Bruckner ◽  
Christian Biegelmayer ◽  
Manfred Schmidbauer ◽  
...  
Keyword(s):  
Pineal Gland ◽  
Limit Of Detection ◽  
Tumor Resection ◽  
Serum Levels ◽  
Pineal Region ◽  
Computer Assisted ◽  
Surgical Removal ◽  
Pineal Tumors ◽  
Pineal Region Tumors ◽  
Computer Assisted Tomography

Abstract The pineal hormone melatonin (MLT) is secreted in a circadian rhythm with high serum levels during nighttime and low serum levels during daytime. Several authors have reported an altered secretion pattern of MLT in patients with pineal tumors and have proposed that MLT may be used as a tumor marker. In nine patients, a pineal region tumor was diagnosed by computer-assisted tomography. Before and after surgical removal of the tumor, several day- and nighttime serum samples were collected and MLT concentrations were estimated by radioimmunoassay. Before operation, five patients presented a normal circadian pattern of MLT secretion. In the remaining four subjects, MLT levels were undetectable or at the limit of detection, with no signs of a circadian secretion pattern. Eight patients were reexamined after tumor resection, when all but one had undetectable or very low MLT levels. The remaining subject, with a pineomesencephalic pilocytic astrocytoma, dislocating but not involving the pineal gland, presented a normal circadian secretion pattern of MLT after operation; in this case, tumor resection was possible without damaging the pineal gland. Thus, before operation, MLT deficiency rather than exaggerated serum levels may be used as a marker for pineal tumors that destroy the pineal gland. After tumor resection, serum MLT may serve to demonstrate complete pinealectomy.

scholarly journals Gamma knife surgery for pineal region tumors: an alternative strategy for negative pathology

2014 ◽  
Vol 72 (2) ◽  
pp. 129-135 ◽  
Author(s):  
Peng Wang ◽  
Qing Mao ◽  
Wei Wang ◽  
Liang-Xue Zhou ◽  
Yan-Hui Liu
Keyword(s):  
Gamma Knife ◽  
Pineal Region ◽  
Gamma Knife Surgery ◽  
Alternative Strategy ◽  
Neurological Deficits ◽  
Pineal Region Tumors ◽  
Total Response Rate ◽  
Spinal Cord Radiotherapy ◽  
Brain And Spinal Cord

Objective : Pineal region tumors (PRTs) are uncommon, and treatments vary among neoplasm types. The authors report their experience with gamma knife surgery (GKS) as an initial treatment in a series of PRT patients with unclear pathological diagnoses. Method : Seventeen PRT patients with negative pathology who underwent GKS were retrospectively studied. Nine patients had further whole-brain and spinal cord radiotherapy and chemotherapy 6–9 months after GKS. Results : Sixteen of 17 cases were followed up over a mean of 33.3 months. The total response rate was 75%, and the control rate was 81.3%. No obvious neurological deficits or complications were attributable to GKS. Conclusion : The findings indicate that GKS may be an alternative strategy in selected PRT patients who have negative pathological diagnoses, and that good outcomes and quality of life can be obtained with few complications.

scholarly journals Primary neuroendocrine tumor of the pineal gland: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Angela Cheng ◽  
Jane Barron ◽  
Oliver Holmes ◽  
Peter Bartlett ◽  
Gregory Jenkins ◽  
...  
Keyword(s):  
Palliative Care ◽  
Pineal Gland ◽  
Neuroendocrine Tumors ◽  
Neuroendocrine Carcinoma ◽  
Alkylating Agent ◽  
Pineal Region ◽  
Primary Lesion ◽  
Disease Entity ◽  
Case Presentation ◽  
Uncommon Disease

Abstract Introduction Primary intracranial neuroendocrine tumors are exceedingly rare, with few cases in the literature. We present a case of a primary neuroendocrine carcinoma of the pineal gland, which is the second that has ever been reported. Case presentation A 53-year-old male patient presented with vomiting, weakness, and headaches. Imaging revealed a lesion in the pineal region, which was surgically resected. This mass was characterized by histology as a neuroendocrine carcinoma, given the presence of neuroendocrine markers and cytokeratin markers with absence of a primary lesion elsewhere on imaging. Conclusions There are currently no guidelines on the management of primary intracranial neuroendocrine tumors. In this case, the patient underwent surgical resection and craniospinal radiotherapy. He subsequently received one cycle of chemotherapy with temozolomide, an alkylating agent, but he unfortunately did not tolerate treatment. A multidisciplinary decision was made along with the patient and his family to focus on palliative care. Eighteen months after the initial presentation, disease recurred in the patient’s neck. The patient underwent resection to control the metastases, with a plan to follow with radiotherapy and chemotherapy. Unfortunately, the patient became unwell and died at 21 months after initial diagnosis. This demonstrates a need for continued research and reporting on this uncommon disease entity.

scholarly journals Combined supra/infratentorial-transsinus approach to large pineal region tumors

1998 ◽  
Vol 4 (4) ◽  
pp. E2
Author(s):  
Ibrahim M. Ziyal ◽  
Laligam N. Sekhar ◽  
Eduardo Salas ◽  
Wayne J. Olan
Keyword(s):  
Venous Pressure ◽  
Tumor Resection ◽  
Occipital Lobe ◽  
Transverse Sinus ◽  
Pineal Region ◽  
Combined Approach ◽  
Pineal Region Tumors ◽  
Before And After ◽  
Nerve Paresis ◽  
Brain Retraction

Object The authors sought to confirm that the combined supra/infratentorial-transsinus approach offers a safer means of resecting large pineal region tumors than other approaches currently being used. The aforementioned method provides a wider exposure of the pineal region with less brain retraction than the infratentorial-supracerebellar or the occipital-transtentorial approach alone and is applicable to some large and giant tumors of this area. This combined approach was used in six patients to remove large pineal region tumors including four tentorial meningiomas, one pineocytoma, and one epidermoid cyst. Methods The transverse sinus and tentorium were sectioned after review of preoperative angiographic studies, after taking intraoperative measurements of the venous pressure in the nondominant transverse sinus before and after clipping and while monitoring the somatosensory evoked potentials. The occipital lobe cortex and cerebellum were retracted slightly along the tentorium. Deep veins of the galenic system, the quadrigeminal area, and the tumor were well exposed. Before it was used for tumor resection the approach was studied in five cadaveric head specimens, and the projection of different approaches was compared radiologically. The tumors were removed in a gross-total manner in all patients, and none of the major veins of the galenic system was injured. Resuturing of the nondominant transverse sinus was performed postoperatively in one patient. One of the six patients experienced transient visual loss, and another suffered mild right sixth cranial nerve paresis; however, both recovered in 3 weeks. The wide exposure of the combined approach was also confirmed on radiological and anatomical studies. Conclusions The combined supra/infratentorial-transsinus approach is preferred for the resection of certain large pineal region tumors.

Transcallosal interforniceal approach to pineal region tumors in 150 children

2011 ◽  
Vol 7 (1) ◽  
pp. 98-103 ◽  
Author(s):  
Wenqing Jia ◽  
Zhenyu Ma ◽  
Isabelle Yisha Liu ◽  
Yuqi Zhang ◽  
Ge Jia ◽  
...  
Keyword(s):  
Short Term Memory ◽  
Tumor Resection ◽  
Germ Cell Tumors ◽  
Pediatric Neurosurgery ◽  
Memory Deficits ◽  
Pineal Region ◽  
Short Term ◽  
Pineal Region Tumors ◽  
Disconnection Syndrome ◽  
Cavernous Hemangiomas

Object Pediatric pineal region tumors are very difficult to cure surgically. The authors used the transcallosal interforniceal approach in patients with these lesions. Methods One hundred fifty children, 98 boys and 52 girls, with pineal region tumors underwent tumor resection via the transcallosal interforniceal approach in the pediatric neurosurgery ward of TianTan Hospital. The patients ranged in age from 1 to 15 years. Fifty-eight patients had mature teratomas; 57, immature teratomas; 14, astrocytomas; 3, glioblastomas; 4, pineoblastomas; 2, pineocytomas; 4, choriocarcinomas; 4, cavernous hemangiomas; 2, germ cell tumors; and 2, epidermoid cysts. Results One hundred twenty-nine tumors were totally removed, 15 were subtotally removed, and 6 were partly removed. There were no deaths and no subsequent instances of disconnection syndrome. Short-term memory deficits appeared in 94 patients but resolved within 6 months in most; only a few patients retained persistent deficits. There were 2 patients with mutism that resolved within 10 days. Parinaud syndrome was observed in 45 patients after surgery; 21 of these cases had appeared preoperatively. The syndrome resolved within 6 months in 31 patients, while it remained in the other 14. Conclusions The transcallosal interforniceal approach appears to be a safe route for pineal region tumors in children, and complete resection can be achieved in the majority of patients.

scholarly journals Endoscope-Assisted Microsurgery in Pediatric Cases With Pineal Region Tumors: A Study of 18 Cases Series

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuankun Cai ◽  
Zhongwei Xiong ◽  
Can Xin ◽  
Jincao Chen ◽  
Kui Liu
Keyword(s):  
Clinical Outcomes ◽  
Remission Rate ◽  
Tumor Resection ◽  
Clinical Manifestations ◽  
Pineal Region ◽  
Pathological Examination ◽  
Karnofsky Performance Score ◽  
Female Ratio ◽  
Pineal Region Tumors ◽  
Postoperative Hydrocephalus

Background: An endoscope-assisted technique was recently introduced to microsurgery (MS) and may compensate for the disadvantages of MS for deep-seated lesions. This study was performed to identify the effectiveness and safety of endoscopic-assisted microsurgery (EAM) and share our experience of EAM for pediatric cases with pineal region tumors.Method: We retrospectively analyzed the clinical data of consecutive pediatric cases with pineal region tumors treated by EAM or MS from January 2016 to June 2020. These data included the patient population, clinical manifestations, preoperative examination findings, surgical approach, pathological results, and clinical outcomes. The clinical outcomes were analyzed in the EAM group and MS group with a focus on the gross total resection (GTR) rate, postoperative hydrocephalus remission rate, and Karnofsky performance score (KPS). Studies on the surgical management of children with pineal region tumors in the last decade were reviewed.Result: Eighteen children successfully underwent tumor resection via MS (n = 8) or EAM (n = 10). The children's mean age was 11.4 ± 4.7 years, and the male to female ratio was 7:2. Seventeen patients (94.4%) complicated preoperative hydrocephalus, and 16 (88.9%) presented headache with nausea and/or vomiting. The pathological examination revealed germ cell tumors in 11 (61.1%) patients, neuroepithelial tumors in 4 (22.2%) patients, and a pineoblastoma, arachnoid cyst, and atypical teratoid rhabdoid tumor in 1 (5.6%) patient each. GTR was more commonly achieved in the EAM than MS group (80.0 vs. 50.0%, respectively), and the postoperative hydrocephalus remission rate was higher in the EAM than MS group (87.5 vs. 50.0%, respectively). At a mean follow-up time of 23.6 ± 11.5 weeks, the mean improvement of the KPS 6 months postoperatively was greater in the EAM than MS group (24.0 ± 9.7 vs. 17.5 ± 7.1 points, respectively).Conclusion: EAM combines endoscopic and microsurgical techniques and can be safely and effectively performed to achieve GTR of pineal region tumors in pediatric patients. In children with pineal region tumors who have obstructive hydrocephalus, EAM could improves hydrocephalus remission rates by checking and clearing the midbrain aqueduct under visualization.

Combined supra/infratentorial—transsinus approach to large pineal region tumors

1998 ◽  
Vol 88 (6) ◽  
pp. 1050-1057 ◽  
Author(s):  
Ibrahim M. Ziyal ◽  
Laligam N. Sekhar ◽  
Eduardo Salas ◽  
Wayne J. Olan
Keyword(s):  
Venous Pressure ◽  
Tumor Resection ◽  
Occipital Lobe ◽  
Transverse Sinus ◽  
Pineal Region ◽  
Combined Approach ◽  
Content Type ◽  
Pineal Region Tumors ◽  
Before And After ◽  
Fine Print

Object. The authors sought to confirm that the combined supra/infratentorial—transsinus approach offers a safer means of resecting large pineal region tumors than other approaches currently being used. The aforementioned method provides a wider exposure of the pineal region with less brain retraction than the infratentorial—supracerebellar or the occipital—transtentorial approach alone and is applicable to some large and giant tumors of this area. This combined approach was used in six patients to remove large pineal region tumors including four tentorial meningiomas, one pineocytoma, and one epidermoid cyst. Methods. The transverse sinus and tentorium were sectioned after review of preoperative angiographic studies, after taking intraoperative measurements of the venous pressure in the nondominant transverse sinus before and after clipping and while monitoring the somatosensory evoked potentials. The occipital lobe cortex and cerebellum were retracted slightly along the tentorium. Deep veins of the galenic system, the quadrigeminal area, and the tumor were well exposed. Before it was used for tumor resection the approach was studied in five cadaveric head specimens, and the projection of different approaches was compared radiologically. The tumors were removed in a gross-total manner in all patients, and none of the major veins of the galenic system was injured. Resuturing of the nondominant transverse sinus was performed postoperatively in one patient. One of the six patients experienced transient visual loss, and another suffered mild right sixth cranial nerve paresis; however, both recovered in 3 weeks. The wide exposure of the combined approach was also confirmed on radiological and anatomical studies. Conclusions. The combined supra/infratentorial—transsinus approach is preferred for the resection of certain large pineal region tumors.

scholarly journals Role of Gamma Knife surgery in the management of pineal region tumors

2007 ◽  
Vol 23 (6) ◽  
pp. E11 ◽  
Author(s):  
Gregory P. Lekovic ◽  
L. Fernando Gonzalez ◽  
Andrew G. Shetter ◽  
Randall W. Porter ◽  
Kris A. Smith ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Gamma Knife ◽  
Primary Treatment ◽  
Pineal Region ◽  
Gamma Knife Surgery ◽  
Neurological Deficits ◽  
Pineal Region Tumors ◽  
Conventional Radiation ◽  
Conventional Radiation Therapy

Object Increasingly, radiosurgery is used to treat pineal region tumors, either as a primary treatment or as an adjunct to conventional radiation therapy. The authors report their experience with Gamma Knife surgery (GKS) for the treatment of pineal region tumors. Methods The authors retrospectively reviewed the charts of all patients undergoing GKS at their institution between 1997 and 2005. Seventeen patients underwent GKS for nonmetastatic tumors of the pineal region. All patients were treated using Leksell Gamma Plan treatment planning software (versions 4.12::5.34). The mean treatment volume was 7.42 cm3 (range 1.2–32.5 cm3). Prescribed doses ranged from 12 to 18 Gy. All doses were prescribed to the 50% isodose line. Independent neuroradiologists reviewed all follow-up imaging studies for evidence of progression of disease. Results One patient (Case 10) died 6 days after GKS. Mean clinical and imaging follow-up in the remaining 16 cases was 31 months. Local control was established during a mean neuroimaging follow-up period of 31 months (range 1–95) in 16 patients (100%). In 2 of these 16 patients (one with an anaplastic astrocytoma, the other with a primitive neuroectodermal tumor), leptomeningeal and spinal spread of tumor developed despite control of the pineal lesions. There were no new neurological deficits attributable to GKS. Three patients died (including the one who died 6 days after GKS) during the follow-up period. Conclusions Excellent control of pineal region brain tumors can be obtained with GKS when it is used in conjunction with surgery, conventional radiation therapy, or both. Patient survival and quality of life can be optimized through the use of multimodal treatment, including surgery, conventional radiation therapy and/or radiosurgery, and chemotherapy, when applicable.

Pineal Region Neoplasms

2017 ◽  
Author(s):  
Neil Haranhalli ◽  
Jerome J. Graber
Keyword(s):  
Pineal Gland ◽  
Germ Cell Tumors ◽  
Pineal Region ◽  
Benign Lesions ◽  
Pineal Tumors ◽  
Pineal Region Tumors ◽  
Inflammatory Conditions ◽  
Cerebrospinal Fluid Biomarkers ◽  
Syndrome Diagnosis ◽  
Parinaud’S Syndrome

Pineal region tumors include a diverse array of neoplasms arising from various components of the pineal gland, including germ cell tumors, germinomas, teratomas, pineocytomas, pineoblastomas, and tumors derived from glial tissues including gliomas, astrocytomas, oligodendrogliomas, and ependymomas. Benign lesions of the pineal gland can include pineal cysts, calcifications and meningiomas. Metastatic tumors can also be found in the pineal region. Numerous infectious and inflammatory conditions can mimic pineal tumors. Most patients present with symptoms of hydrocephalus or Parinaud’s syndrome. Diagnosis often requires biopsy, though some germinomas may be diagnosed based solely on serum and cerebrospinal fluid biomarkers.

scholarly journals Papillary tumor of the pineal region

2017 ◽  
Vol 4 (12) ◽  
pp. 4076
Author(s):  
Murat Zaimoglu ◽  
Fatih Yakar ◽  
Ihsan Dogan ◽  
Yusuf Sukru Caglar
Keyword(s):  
Pineal Gland ◽  
Histopathological Examination ◽  
Pineal Region ◽  
Pineal Tumor ◽  
Intracranial Tumors ◽  
Surgical Experience ◽  
Recurrence Rates ◽  
Papillary Tumor ◽  
Pineal Region Tumors ◽  
Supracerebellar Infratentorial Approach

Pineal region tumors make up 0.4-1.0% of intracranial tumors in adults. These tumors may arise from pineal gland itself or structures around pineal gland which are all termed as pineal region tumors. Papillary tumor of the pineal region is a non-parenchymal tumor of the pineal region. It was first documented in 2003. We presented a 21 years old female patient with pineal tumor. Supracerebellar infratentorial approach was performed. The total excision of the lesion was achieved successfully. Histopathological examination revealed papillary tumor of the pineal region. The case is discussed in the light of our preoperative surgical experience, its pre-and post-operative radiological and histopathological evaluation. Supracerebellar infratentorial approach is encountered as the favoured approach generally. As recurrence rates are high, adjuvant treatment is advised after surgery. Further research on this pathology will enlighten the neurosurgeons for effective treatment.

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