Difference between revisions of "Pineal gland"
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Another ref.:<ref>URL: [http://www.springerlink.com/content/k4v88n6h6jknhp2t/fulltext.pdf http://www.springerlink.com/content/k4v88n6h6jknhp2t/fulltext.pdf]. Accessed on: 9 December 2010.</ref> | Another ref.:<ref>URL: [http://www.springerlink.com/content/k4v88n6h6jknhp2t/fulltext.pdf http://www.springerlink.com/content/k4v88n6h6jknhp2t/fulltext.pdf]. Accessed on: 9 December 2010.</ref> | ||
==Pineal parenchymal tumor of intermediate differentiation== | |||
===General=== | |||
*20% of all pineal tumors. | |||
*Affects all ages. | |||
*ICD-O: 9362/3 | |||
*No WHO grade yet, clinical behaviour corresponds to grade II/III<ref>{{Cite journal | last1 = Jouvet | first1 = A. | last2 = Saint-Pierre | first2 = G. | last3 = Fauchon | first3 = F. | last4 = Privat | first4 = K. | last5 = Bouffet | first5 = E. | last6 = Ruchoux | first6 = MM. | last7 = Chauveinc | first7 = L. | last8 = Fèvre-Montange | first8 = M. | title = Pineal parenchymal tumors: a correlation of histological features with prognosis in 66 cases. | journal = Brain Pathol | volume = 10 | issue = 1 | pages = 49-60 | month = Jan | year = 2000 | doi = | PMID = 10668895 }}</ref> | |||
===Microscopic=== | |||
Features:<ref>{{Cite journal | last1 = Fèvre-Montange | first1 = M. | last2 = Szathmari | first2 = A. | last3 = Champier | first3 = J. | last4 = Mokhtari | first4 = K. | last5 = Chrétien | first5 = F. | last6 = Coulon | first6 = A. | last7 = Figarella-Branger | first7 = D. | last8 = Polivka | first8 = M. | last9 = Varlet | first9 = P. | title = Pineocytoma and pineal parenchymal tumors of intermediate differentiation presenting cytologic pleomorphism: a multicenter study. | journal = Brain Pathol | volume = 18 | issue = 3 | pages = 354-9 | month = Jul | year = 2008 | doi = 10.1111/j.1750-3639.2008.00128.x | PMID = 18371183 }}</ref> | |||
*High cellularity. | |||
*Mild to moderate atypia. | |||
*Mitoses. | |||
*Usually no pinecytomatous rosettes. | |||
*High pleomorphism possible. | |||
Images: | |||
<gallery> | |||
File:Pinealis parechymal tumor.jpg | PPID, Smear (WC/jensflorian) | |||
</gallery> | |||
==Papillary Tumor of Pinealis region (PTPR)== | |||
===General=== | |||
*Very rare neuoepithelial tumor of adults. | |||
*Proposed ICD-O: 9395/3 | |||
*No WHO grade yet, clinical behaviour corresponds to grade II/III<ref>{{Cite journal | last1 = Fèvre-Montange | first1 = M. | last2 = Hasselblatt | first2 = M. | last3 = Figarella-Branger | first3 = D. | last4 = Chauveinc | first4 = L. | last5 = Champier | first5 = J. | last6 = Saint-Pierre | first6 = G. | last7 = Taillandier | first7 = L. | last8 = Coulon | first8 = A. | last9 = Paulus | first9 = W. | title = Prognosis and histopathologic features in papillary tumors of the pineal region: a retrospective multicenter study of 31 cases. | journal = J Neuropathol Exp Neurol | volume = 65 | issue = 10 | pages = 1004-11 | month = Oct | year = 2006 | doi = 10.1097/01.jnen.0000240462.80263.13 | PMID = 17021405 }}</ref> | |||
Gross: | |||
*Well circumscribed. | |||
*Can be quite large (2-4cm). | |||
*Macroscopy mimics pineocytoma. | |||
<gallery> | |||
File:PTPR MRI.jpg | PTPR MRI scan (WC/marvin101) | |||
</gallery> | |||
===Microscopic=== | |||
Features:<ref>{{Cite journal | last1 = Heim | first1 = S. | last2 = Beschorner | first2 = R. | last3 = Mittelbronn | first3 = M. | last4 = Keyvani | first4 = K. | last5 = Riemenschneider | first5 = MJ. | last6 = Vajtai | first6 = I. | last7 = Hartmann | first7 = C. | last8 = Acker | first8 = T. | last9 = Blümcke | first9 = I. | title = Increased mitotic and proliferative activity are associated with worse prognosis in papillary tumors of the pineal region. | journal = Am J Surg Pathol | volume = 38 | issue = 1 | pages = 106-10 | month = Jan | year = 2014 | doi = 10.1097/PAS.0b013e31829e492d | PMID = 24121176 }}</ref> | |||
*Papillary growth pattern. | |||
*Dense areas exhibit ependymal features. | |||
**Clear, vacuolated cytoplasm. | |||
**Rosettes. | |||
*Round to oval nuclei. | |||
*Mitoses (0-10/HPF). | |||
*Necroses. | |||
*Hyalinized vessels. | |||
===IHC=== | |||
* +ve for keratins (KL1, AE1/AE3, Cam5.2, CK18). | |||
* GFAP and Synaptophysin focally +ve. | |||
* S100+ve. | |||
* EMA mostly -ve. | |||
* NF and Kir 7.1-ve. | |||
DDx: | |||
[[Ependymoma]]. | |||
Images: | |||
<gallery> | |||
File:PTPR papillary tumor pinealis HE.jpg | PTPR H&E stain (WC/jensflorian) | |||
File:PTPR KL1.jpg | PTPR CK KL1 (WC/marvin101) | |||
File:PTPR papillary tumor pinealis CK18.jpg | PTPR CK18 IHC (WC/jensflorian) | |||
File:PTPR EMA.jpg | PTPR EMA IHC (WC/marvin101) | |||
File:PTPR Kir71.jpg | PTPR Kir 7.1 IHC (WC/marvin101) | |||
</gallery> | |||
==Pineoblastoma== | ==Pineoblastoma== | ||
| Line 67: | Line 132: | ||
*Males > females. | *Males > females. | ||
*Children & young adults. | *Children & young adults. | ||
*Corresponds to WHO IV (ICD-O: 9362/3) | |||
===Microscopic=== | ===Microscopic=== | ||
| Line 73: | Line 139: | ||
*Mitoses. | *Mitoses. | ||
*Nuclear atypia. | *Nuclear atypia. | ||
*Homer-wright & Flexner-Winterstein rosettes | |||
*Fleurettes. | |||
===IHC=== | |||
*GFAP -ve/+ve. | |||
*NF+ve. | |||
*Synaptophysin+ve | |||
*MIB-1: high. | |||
DDx: | DDx: | ||
*[[Glioblastoma]]. | *[[Glioblastoma]], small cell variant. | ||
*[[Small round cell tumors]]. | |||
Images: | Images: | ||
*[http://path.upmc.edu/cases/case212.html Pineoblastoma - several images (upmc.edu)]. | *[http://path.upmc.edu/cases/case212.html Pineoblastoma - several images (upmc.edu)]. | ||
<gallery> | |||
File:Pineoblastoma HE x200.jpg | Pineoblastoma H&E (WC/jensflorian) | |||
File:Pineoblastoma neurofilament.jpg | Neurofilament IHC in Pineoblastoma (WC/jensflorian) | |||
File:Pineoblastoma gfap.jpg | GFAP IHC in Pineoblastoma (WC/jensflorian) | |||
</gallery> | |||
==See also== | ==See also== | ||
Revision as of 13:02, 14 April 2015
The pineal gland is thingy that is most noted for the fact that it calcifies with age.
Normal histology
- Cellular.
Overview
Tumours:[1]
- Primary pineal tumours ~15% of (pineal) tumours - benign to malignant:[2]
- Pineocytoma.
- Pineal parenchymal tumor of intermediate differentiation.
- Pineoblastoma.
- Germ cell tumours:
- Germinoma ~ 50% of (pineal) tumours.
- Teratoma ~ 15% of tumours.
- Choriocarcinoma ~ 5% of tumours.
- Others:
- Direct invasion/extension from surrounding structures (astrocytomas).
- Metastases.
- Lipomas.
- Meningiomas.
Primary pineal tumours
Range from benign to malignant.
Pineocytoma
General
- Benign tumour of the pineal gland.
- WHO Grade I.
Microscopic
Features:
- Cytologically benign cells (uniform size of nuclei, regular nuclear membrane, light chromatin).
- Pineocytomatous/neurocytic rosette = (irregular) rosette with a large meshwork of fibers (neuropil) at the centre.[3]
- Similar to Homer-Wright rosette... but:
- Neuropil centre is larger in pineocytoma.
- Edge of neuropil meshwork irregular.
- Similar to Homer-Wright rosette... but:
Notes:
- Rosette = circular/flower-like arrangement of cells.
Images
Pineocytoma - intermed. mag. (WC)
Pineocytoma - high mag. (WC)
Pineocytoma - very high mag. (WC)
IHC
- Synaptophysin +ve.
- Chromogranin A -ve.
- NSE +ve (cytoplasmic + nuclear).[4]
- GFAP -ve.
- +ve in gliomas.
- PLAP -ve.
- Usu. +ve in germ cell tumours.
- Ki-67.
Another ref.:[5]
Pineal parenchymal tumor of intermediate differentiation
General
- 20% of all pineal tumors.
- Affects all ages.
- ICD-O: 9362/3
- No WHO grade yet, clinical behaviour corresponds to grade II/III[6]
Microscopic
Features:[7]
- High cellularity.
- Mild to moderate atypia.
- Mitoses.
- Usually no pinecytomatous rosettes.
- High pleomorphism possible.
Images:
PPID, Smear (WC/jensflorian)
Papillary Tumor of Pinealis region (PTPR)
General
- Very rare neuoepithelial tumor of adults.
- Proposed ICD-O: 9395/3
- No WHO grade yet, clinical behaviour corresponds to grade II/III[8]
Gross:
- Well circumscribed.
- Can be quite large (2-4cm).
- Macroscopy mimics pineocytoma.
PTPR MRI scan (WC/marvin101)
Microscopic
Features:[9]
- Papillary growth pattern.
- Dense areas exhibit ependymal features.
- Clear, vacuolated cytoplasm.
- Rosettes.
- Round to oval nuclei.
- Mitoses (0-10/HPF).
- Necroses.
- Hyalinized vessels.
IHC
- +ve for keratins (KL1, AE1/AE3, Cam5.2, CK18).
- GFAP and Synaptophysin focally +ve.
- S100+ve.
- EMA mostly -ve.
- NF and Kir 7.1-ve.
DDx: Ependymoma.
Images:
PTPR H&E stain (WC/jensflorian)
PTPR CK KL1 (WC/marvin101)
PTPR CK18 IHC (WC/jensflorian)
PTPR EMA IHC (WC/marvin101)
PTPR Kir 7.1 IHC (WC/marvin101)
Pineoblastoma
General
- Rare.
- Malignant.
- Males > females.
- Children & young adults.
- Corresponds to WHO IV (ICD-O: 9362/3)
Microscopic
Features:
- Hypercellular.
- Mitoses.
- Nuclear atypia.
- Homer-wright & Flexner-Winterstein rosettes
- Fleurettes.
IHC
- GFAP -ve/+ve.
- NF+ve.
- Synaptophysin+ve
- MIB-1: high.
DDx:
- Glioblastoma, small cell variant.
- Small round cell tumors.
Images:
Pineoblastoma H&E (WC/jensflorian)
Neurofilament IHC in Pineoblastoma (WC/jensflorian)
GFAP IHC in Pineoblastoma (WC/jensflorian)
See also
References
- ↑ Gaillard F, Jones J (October 2010). "Masses of the pineal region: clinical presentation and radiographic features". Postgrad Med J 86 (1020): 597–607. doi:10.1136/pgmj.2009.087460. PMID 20971711.
- ↑ Smith AB, Rushing EJ, Smirniotopoulos JG (November 2010). "From the archives of the AFIP: lesions of the pineal region: radiologic-pathologic correlation". Radiographics 30 (7): 2001–20. doi:10.1148/rg.307105131. PMID 21057132.
- ↑ Wippold FJ, Perry A (March 2006). "Neuropathology for the neuroradiologist: rosettes and pseudorosettes". AJNR Am J Neuroradiol 27 (3): 488–92. PMID 16551982.
- ↑ URL: http://path.upmc.edu/cases/case157/dx.html. Accessed on: 9 December 2010.
- ↑ URL: http://www.springerlink.com/content/k4v88n6h6jknhp2t/fulltext.pdf. Accessed on: 9 December 2010.
- ↑ Jouvet, A.; Saint-Pierre, G.; Fauchon, F.; Privat, K.; Bouffet, E.; Ruchoux, MM.; Chauveinc, L.; Fèvre-Montange, M. (Jan 2000). "Pineal parenchymal tumors: a correlation of histological features with prognosis in 66 cases.". Brain Pathol 10 (1): 49-60. PMID 10668895.
- ↑ Fèvre-Montange, M.; Szathmari, A.; Champier, J.; Mokhtari, K.; Chrétien, F.; Coulon, A.; Figarella-Branger, D.; Polivka, M. et al. (Jul 2008). "Pineocytoma and pineal parenchymal tumors of intermediate differentiation presenting cytologic pleomorphism: a multicenter study.". Brain Pathol 18 (3): 354-9. doi:10.1111/j.1750-3639.2008.00128.x. PMID 18371183.
- ↑ Fèvre-Montange, M.; Hasselblatt, M.; Figarella-Branger, D.; Chauveinc, L.; Champier, J.; Saint-Pierre, G.; Taillandier, L.; Coulon, A. et al. (Oct 2006). "Prognosis and histopathologic features in papillary tumors of the pineal region: a retrospective multicenter study of 31 cases.". J Neuropathol Exp Neurol 65 (10): 1004-11. doi:10.1097/01.jnen.0000240462.80263.13. PMID 17021405.
- ↑ Heim, S.; Beschorner, R.; Mittelbronn, M.; Keyvani, K.; Riemenschneider, MJ.; Vajtai, I.; Hartmann, C.; Acker, T. et al. (Jan 2014). "Increased mitotic and proliferative activity are associated with worse prognosis in papillary tumors of the pineal region.". Am J Surg Pathol 38 (1): 106-10. doi:10.1097/PAS.0b013e31829e492d. PMID 24121176.