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 »  Abstract
 »  Introduction
 »  Case Report
 »  Discussion
 »  References
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TOPIC OF THE ISSUE: CASE REPORT
Year : 2010  |  Volume : 58  |  Issue : 6  |  Page : 928-932

Advanced magnetic resonance imaging with histopathological correlation in papillary tumor of pineal region: Report of a case and review of literature


1 Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
2 Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
3 Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

Date of Acceptance04-Oct-2010
Date of Web Publication10-Dec-2010

Correspondence Address:
B Thomas
Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala - 695 011
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.73750

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 » Abstract 

Papillary tumors of the pineal region are recently described as rare mass lesions with limited literature available on their natural history and imaging features. Magnetic resonance imaging (MRI) including perfusion, diffusion, and spectroscopic features were described in an 18-year-old girl with papillary tumor of pineal region. A well-defined, T1 hyperintense and contrast-enhancing mass lesion was noted in pineal region with few cystic spaces within. Solid portion of lesion showed minimal diffusion restriction with average apparent diffusion coefficient of 0.812 Χ 10 -3 mm 2 /s; on MR spectroscopy elevated myo-inositol peak with reduced N-acetylaspartate and elevated choline in the tumor. On perfusion study there was significantly high relative cerebral blood volume (rCBV) (6-9 times) and relative cerebral blood flow (rCBF). Our findings agree with previous descriptions of cystic areas with T1 hyperintense appearance of this tumor but very high level of tumor perfusion, diffusion restriction, and presence of myo-inositol peak are important imaging findings and may correlate with the recent reports of high tumor recurrence in these cases.


Keywords: DWI, MRI, magnetic resonance spectroscopy, papillary tumor of the pineal region, perfusion


How to cite this article:
Vaghela V, Radhakrishnan N, Radhakrishnan V V, Menon G, Kesavadas C, Thomas B. Advanced magnetic resonance imaging with histopathological correlation in papillary tumor of pineal region: Report of a case and review of literature. Neurol India 2010;58:928-32

How to cite this URL:
Vaghela V, Radhakrishnan N, Radhakrishnan V V, Menon G, Kesavadas C, Thomas B. Advanced magnetic resonance imaging with histopathological correlation in papillary tumor of pineal region: Report of a case and review of literature. Neurol India [serial online] 2010 [cited 2019 May 25];58:928-32. Available from: http://www.neurologyindia.com/text.asp?2010/58/6/928/73750



 » Introduction Top


Papillary tumor of the pineal region (PTPR) is a recently described distinct clinicopathological entity with limited evidence on its clinical behavior, natural history, and characteristic imaging features. [1] These tumors are thought to arise from the specialized ependymocytes of the subcommissural organ located in the lining of the posterior commissure. [2] Histologically, PTPR demonstrates a unique assortment of epithelial, ependymal, and neuroendocrine features. [3] According to descriptions in radiological literature, these tumors are hyperintense on T1W images and may show few cystic areas. [4],[5] This may resemble pineocytoma on imaging. [6] We describe advanced MR imaging features like perfusion, diffusion, and spectroscopic findings in a histologically proven case of PTPR. We also review the literature on the same.


 » Case Report Top


An 18-year-old girl presented with history of recurrent right temporo-parietal headache associated with nausea without any diurnal variations. She also complained of intermittent double vision especially on looking to the left. The neurological examination was unremarkable.

MR imaging on a 1.5T scanner (Avanto-SQ engine, Siemens, Erlangen, Germany) revealed a mass at the pineal region, which was extending into the posterior third ventricle and was compressing the tectal plate from above. The mass was hyperintense on non-contrast T1-weighted images with presence of a few cystic areas, which were hypointense on T1 and FLAIR images. The mass showed heterogeneous contrast enhancement. The solid portions of the mass showed minimal restriction on diffusion weighted images. The average apparent diffusion coefficient of the lesion was 0.812 Χ 10 -3 mm 2 /s. It was showing a solitary focus of blooming on susceptibility weighted imaging, which might be due to calcification/bleed. Proton MR spectroscopy revealed increased choline, increased myo-inositol and decreased N-acetyl aspartate peaks with a small lactate peak. On perfusion imaging, lesion showed significantly elevated relative cerebral blood volume (rCBV) and relative cerebral blood low (rCBF) of 6-9 times compared to normal white matter [Figure 1]. The patient underwent ventriculostomy and surgical resection of the mass.
Figure 1: Axial T1W image (a) shows well-defined hyperintense lesion in pineal region with few hypointense foci corresponding to cystic areas. The lesion is hyperintense on T2W image (not shown here). Post-contrast Sagittal T1W (b) image shows heterogeneous enhancement of the mass lesion. Mass is showing diffusion restriction on diffusion image (c) and ADC map (d). On susceptibility image (e) there is e/o focal area of blooming. CISS image (f) showing solid mass with multiple cystic spaces within it. MR spectroscopy map (g and h) showing elevated peaks of myo-inositol and choline. Perfusion imaging (I and j) with color-coded images of the cerebral blood volume (CBV; i) cerebral blood flow (CBF; j), showing increase perfusion within the lesion

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Hematoxylin and Eosin stained sections of the tissue obtained showed a cellular neoplasm exhibiting papillary areas as well as solid growth pattern [Figure 2]. Papillary areas were composed of cells with moderate amount of eosinophilic cytoplasm, round to oval nuclei, whereas the solid areas showed cells with eosinophilic as well as clear cytoplasm. Neither mitotic figures nor necrosis was seen. In our case, the sections were stained for cytokeratin (Dako, pre-diluted), S-100 (Dako, 1 : 100), neuron-specific enolase (NSE, Dako, 1 : 50), glial fibrillary acidic protein (GFAP, Novacastra, 1 : 100), and epithelial membrane antigen (EMA, Dako 1 : 100) [Table 1].
Figure 2: Photomicrograph showing neoplastic cells in papillary pattern (a) and the solid areas (b) (Hematoxylin and Eosin × 200). There was immunopositivity for S-100 and NSE (c, d) and immunonegativity for GFAP (e) (Original magnification 400× )

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Table 1: Immunohistochemical profile of PTPR (Present case)

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The neoplastic cells were diffusely immunoreactive for cytokeratin and S-100 antibodies. Isolated and small clusters of cells were immunoreactive for neuron-specific enolase. Immunohistochemistry for epithelial membrane antigen and GFAP were negative. The tumor morphology and immunohistochemical profile was typical of PTPR.


 » Discussion Top


Wide range of neoplasm occurs in the pineal region and they constitute diagnostic challenge in both radiological and pathological point of view. 'Papillary tumors of the pineal region' has been added recently to this list, which is a rare tumor, with uncertain prognosis, and a possible high risk for local recurrence. [7]

Jouvet et al. in 2003 described for the first time, papillary tumor of the pineal region, which was formally recognized as a distinct entity by the 2007 WHO Classification of Brain Tumors. [8] In 2004, Shibahara et al. confirmed the origin of these tumors from specialized ependyma of the subcommissural organ (SCO) by showing transthyretin expression of the tumor, as transthyretin is one of the proteins presumed to be secreted by human SCO. [9],[10] The SCO is an ependymal brain gland located in the third ventricle, at the entrance of the third ventricle, and secretes glycoproteins into the ventricular cerebrospinal fluid. [11],[12],[13] The histopathology of papillary tumors of the pineal region (PTPR) closely resembles that of ependymomas and choroid plexus tumors as they display histopathologic features of ependymal differentiation from which it can be differentiated by absent staining for epithelial membrane antigen, Kir7.1 and staniocalcin-1 as well as the presence of distinct MAP-2 immunoreactivity. [14],[15],[16] Other tumors of the pineal region that may exhibit papillary features include metastatic papillary carcinomas, pineal parenchymal tumors, and meningiomas. [17],[18]

Fevre-Montange et al. presented one of the largest series of PTPR consisting of 31 patients, and suggested five-year estimates for overall and progression-free survival of 73% and 27%, respectively. [19] They also noted that these tumors are characterized by frequent local recurrence and should be addressed with radiotherapy. Clinically, age of occurrence is wide, ranging from 5 to 66 years with mean age of 29 years. From available reports we found slight female predominance of incidence with peak incidence occurring at different age group in male and female sex [Figure 3]. Few reports suggest that PTPR have high risk of recurrence (72%) especially if there is residual lesion after resection. [20] Sato et al. reported a case with early CSF dissemination and relentless progression in spite of intensive chemotherapy and comprehensive radiotherapy. [21] Main clinical and radiological data of patients of reviewed articles are summarized in [Table 2].
Figure 3: Age and sex distribution of 47 patients with PTPR is given from the reviewed articles

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Table 2: Summary of reports of PTPR describing natural history and imaging findings

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Very few authors have studied the MR imaging appearance of PTPR. One report has described PTPR as T1 hypointense lesion. [22] We found three reports which have described T1 hyperintensity of these tumors as is in our case. [4],[5],[21] Explanation given for T1 hyperintensity is presence of proteins and glycoproteins in the small cystic spaces seen within these tumors. [4] On T2-weighted images these lesions are iso to hypointense and shows inhomogeneous enhancement on post-contrast T1W images. Inoue et al. and others have reported cystic areas within these lesions as also seen in our case. [23],[24] In our case, solid region of the tumor shows diffusion restriction with ADC value of 0.812 Χ 10 -3 mm 2 /s. Two reports have given the ADC value of these tumors (0.854 Χ 10 -3 mm 2 /s; 0.60 Χ 10 -3 mm 2 /s). [5],[23] Proton MR spectroscopy of these tumors showed increased choline and decreased N-acetyl aspartate peaks with a slightly increased lactate peak. We noted similar findings in addition to a high myo-Inositol peak in the present case.

To the best of our knowledge, perfusion characteristic of this tumor has not been reported previously. In this case we noted a high rCBV and rCBF. A high perfusion pattern usually corresponds to a higher grade of the tumor with few exceptions. [25],[26],[27],[28] Perfusion pattern of other pineal region tumors like germinoma can show high perfusion (rCBV ratio 4.7-4.8). Inoue et al. has observed highly significant 18 [F] fluorodeoxyglucose uptakes at the site of the lesion on PET imaging. [23] Sato et al. also reported a case of PTPR with intense uptake of 111 In-DTPA-pentetreotide in a young boy with rapid CSF dissemination and poor prognosis. [21] Thus, high tracer uptake and rCBV may imply a higher grade in view of high recurrence rate of these tumors. [29]

Differentiation of this tumor from other tumors of pineal region is necessary as natural history and behavior of this tumor is not yet clear and has reported high recurrence rate of this tumors. Radiological differential diagnosis of mass lesion in this region includes germinoma, pineocytoma, pineoblastoma, and teratoma. The points for differentiation between these lesions from PTPR are given in [Table 3]. T1 hyperintensity and higher perfusion values may help in differentiating PTPR from other pineal region tumors. From the available literature, these tumors appear well-defined and usually less than 4 cm in size. [30],[31] These features may help differentiating these tumors from pineoblastoma and glioma, which are usually infiltrative and larger in size.
Table 3: Comparison of imaging features of PTPR with common pineal region tumors

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Treatment guidelines of these tumors are not yet well established due to limited case data. [32],[33] The biological behavior of PTPR is variable and may correspond to WHO grades II or III, but precise histological grading criteria remain to be defined. [34]

Our study is limited by single case report; however, larger imaging study with more number of patients and long-term follow-up may be required for developing MR diagnostic criteria and grading of these tumors.

 
 » References Top

1.Jouvet A, Fauchon F, Liberski P, Saint-Pierre G, Didier-Bazes M, Heitzmann A, et al. Papillary tumor of the pineal region. Am J Surg Pathol 2003;27:505-12.  Back to cited text no. 1
    
2.Hasselblatt M, Blümcke I, Jeibmann A, Rickert CH, Jouvet A, van de Nes JA, et al. Immunohistochemical profile and chromosomal imbalances in papillary tumours of the pineal region. Neuropathol Appl Neurobiol 2006;32:278-83.  Back to cited text no. 2
    
3.Tibor B, Sophie A, Michael M, Richard B, Elizabeth C. Case Report Papillary tumor of the pineal region. Neuropathology 2008;28:87-92.  Back to cited text no. 3
    
4.Chang AH, Fuller GN, Debnam JM, Karis JP, Coons SW, Ross JS, et al. MR imaging of papillary tumor of the pineal region. AJNR Am J Neuroradiol 2008;29:187-9.  Back to cited text no. 4
    
5.Cerase A, Vallone IM, Di Pietro G, Oliveri G, Miracco C, Venturi C. Neuroradiological follow up of the growth of papillary tumor of the pineal region: a case report. J Neurooncol 2009;95:433-5.  Back to cited text no. 5
    
6.Brat DJ, Parisi JE, Kleinschmidt-DeMasters BK, Yachnis AT, Montine TJ, Boyer PJ, et al. Surgical neuropathology update: a review of changes introduced by the WHO classification of tumours of the central nervous system, 4th ed. Arch Pathol Lab Med 2008;132:993-1007.  Back to cited text no. 6
    
7.Buffenoir K, Rigoard P, Wager M, Ferrand S, Coulon A, Blanc JL, et al. Papillary tumor of the pineal region in a child: case report and review of the literature. Childs Nerv Syst 2008;24:379-84.  Back to cited text no. 7
    
8.Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol (Berl) 2007;114:97-109.  Back to cited text no. 8
    
9.Shibahara J, Todo T, Morita A, Mori H, Aoki S, Fukayama M. Papillary neuroepithelial tumor of the pineal region. A case report. Acta Neuropathol (Berl) 2004;108:337-40.  Back to cited text no. 9
    
10.Sharma MC, Jain D, Sarkar C, Suri V, Garg A, Sharma BS, et al. Papillary tumor of the pineal region--a recently described entity: a report of three cases and review of the literature. Clin Neuropathol 2009;28:295-302.  Back to cited text no. 10
    
11.Leonardt H. Ependym und circumventriculäre Organe. In: Oksche A, Vollrath L, editors. Neuroglia I: Handbuch der mikroskopischen Anatomie des Menschen. Springer; Berlin: 1980. p. 177-665.  Back to cited text no. 11
    
12.Meiniel A. The secretory ependymal cells of the subcommissural organ: which role in hydrocephalus? Int J Biochem Cell Biol 2007;39:463-8.  Back to cited text no. 12
    
13.Perez-Figares JM, Jimenez AJ, Rodriguez EM. Subcommissural organ, cerebrospinal fluid circulation, and hydrocephalus. Microsc Res Tech 2001;52:591-607.  Back to cited text no. 13
    
14.Santarius T, Joseph JA, Tsang KT, O'Donovan DG, Kirollos RW. Papillary tumour of the pineal region. Br J Neurosurg 2008;22:116-20.  Back to cited text no. 14
    
15.Lehman NL. Central nervous system tumors with ependymal features: a broadened spectrum of primarily ependymal differentiation. J Neuropathol Exp Neurol 2008;67:177-88.  Back to cited text no. 15
    
16.Rodriguez EM, Oksche A, Montecinos H. Human subcommissural organ, with particular emphasis on its secretory activity during the fetal life. Microsc Res Tech 2001;52:573-90.  Back to cited text no. 16
    
17.Trojanowski JQ, Tascos NA, Rorke LB. Malignant pineocytoma with prominent papillary features. Cancer 1982;50:1789-93.  Back to cited text no. 17
    
18.Vaquero J, Coca S, Martinez R, Escandon J. Papillary pineocytoma. Case report. J Neurosurg 1990;73:135-7.  Back to cited text no. 18
    
19.Fèvre-Montange M, Hasselblatt M, Figarella-Branger D, Chauveinc L, Champier J, Saint-Pierre G, et al. Prognosis and histopathologic features in papillary tumors of the pineal region: a retrospective multicenter study of 31 cases. J Neuropathol Exp Neurol 2006;65:1004-11.  Back to cited text no. 19
    
20.Yano H, Ohe N, Nakayama N, Shinoda J, Iwama T. Clinicopathological features from long-term observation of a papillary tumor of the pineal region (PTPR): a case report. Brain Tumor Pathol 2009;26:83-8.  Back to cited text no. 20
    
21.Sato TS, Kirby PA, Buatti JM, Moritani T. Papillary tumor of the pineal region: report of a rapidly progressive tumor with possible multicentric origin. Pediatr Radiol 2009;39:188-90.  Back to cited text no. 21
    
22.Amemiya S, Shibahara J, Aoki S, Takao H, Ohtomo K. Recently established entities of central nervous system tumors: review of radiological findings. J Comput Assist Tomogr 2008;32:279-85.  Back to cited text no. 22
    
23.Inoue T, Kumabe T, Kanamori M, Sonoda Y, Watanabe M, Tominaga T. Papillary tumor of the pineal region: a case report. Brain Tumor Pathol 2008;25:85-90.  Back to cited text no. 23
    
24.Kern M, Robbins P, Lee G, Watson P. Papillary tumor of the pineal region--a new pathological entity. Clin Neuropathol 2006;25:185-92.  Back to cited text no. 24
    
25.Cho SK, Na DG, Ryoo JW, Roh HG, Moon CH, Byun HS, et al. Perfusion MR Imaging: clinical utility for the differential diagnosis of various brain tumors. Korean J Radiol 2002;3:171-9.   Back to cited text no. 25
    
26.Provenzale JM, Mukundan S, Barboriak DP. Diffusion-weighted and perfusion MR imaging for brain tumor characterization and assessment of treatment response. Radiology 2006;239:632-49.  Back to cited text no. 26
    
27.Warmuth C, Gunther M, Zimmer C. Quantification of blood flow in brain tumors: comparison of arterial spin labeling and dynamic susceptibility-weighted contrast-enhanced MR imaging. Radiology 2003;228:523-32.  Back to cited text no. 27
    
28.Lόdemann L, Grieger W, Wurm R, Budzisch M, Hamm B, Zimmer C. Comparison of dynamic contrast-enhanced MRI with WHO tumor grading for gliomas. Eur Radiol 2001;11:1231-41.  Back to cited text no. 28
    
29.Higano S, Yun X, Kumabe T, Watanabe M, Mugikura S, Umetsu A, et al. Malignant astrocytic tumors: clinical importance of apparent diffusion coefficient in prediction of grade and prognosis. Radiology 2006;241:839-46.  Back to cited text no. 29
    
30.Dagnew E, Langford LA, Lang FF, DeMonte F. Papillary tumors of the pineal region: case report. Neurosurgery 2007;60:E953-5.  Back to cited text no. 30
    
31.Kawahara I, Tokunaga Y, Yagi N, Iseki M, Abe K, Hayashi T, et al. Papillary tumor of the pineal region. Neurol Med Chir (Tokyo) 2007;47:568-71.  Back to cited text no. 31
    
32.Cennachi G, Giangaspero F. Emerging tumor entities and variants of CNS neoplasms. J Neuropathol Exp Neurol 2004;63:185-92.  Back to cited text no. 32
    
33.Kuchelmiester K, Hugens-Penzel M, Jodicke A, Schachenmayr W. Papillary tumor of the pineal region. histodiagnostic considerations. Neuropathol Apply Neurobiol 2006;32:203-8.  Back to cited text no. 33
    
34.Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classifcation of tumours of the central nervous system. Acta Neuropathol 2007;114:97-109.  Back to cited text no. 34
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]

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