Clinical Experience of Pineal Parenchymal Tumors.

Park, Kwan Woong; Kim, Jeong Hoon; Kim, Chang Jin; Ra, Young Shin; Lee, Jung Kyo

Original Article

Journal of Korean Neurosurgical Society 2004;36(2): 102-106.

Kwan Woong Park, Jeong Hoon Kim, Chang Jin Kim, Young Shin Ra, Jung Kyo Lee

Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea. jhkim1@amc.seoul.kr

ABSTRACT

OBJECTIVE
Pineal parenchymal tumors (PPT) are rare; therefore, only limited clinical data regarding their behavior is available. The aim of this study is to evaluate the pathologic features, clinical behavior, and response to therapy of these tumors. METHODS: Thirteen patients with biopsy-proven PPT were treated from September 1992 to February 2004 in our hospital. Their medical records and radiologic studies were analyzed retrospectively. The tumors were divided into three groups: pineocytoma, pineoblastoma, and mixed pineocytoma-pineoblastoma or PPT with intermediate differentiation. Initial stages were made by spinal magnetic resonance images and cerebrospinal fluid cytology. Magnetic resonance images were used for defining the treatment response of the patients. RESULTS: The patients were divided into 4 pineocytomas, 5 pineoblastomas, and 4 mixed/intermediate PPT. The patients aged from 2 to 77 years. The patients presented with headache, nausea, vomiting, memory and gait disturbances, and impaired vision. Only one patient showed disseminated disease at initial staging. All patients that had surgery showed improvements of hydrocephalus. Two patients showed complete responses to treatment, six showed partial responses, two showed stable diseases, and two showed disease progression. Eleven patients were alive, but two were dead due to disease progression. CONCLUSION: Obtaining a tissue diagnosis in patients with PPT is important. Although our experience is limited, we consider that multimodality therapies including surgical resection, radiotherapy, chemotherapy, and radiosurgery must be considered for better outcome in treating patients with PPT. More experience is necessary to determine the optimal treatments of PPT.

Key Words: Pineal parenchymal tumors; Surgery; Radiotherapy; Chemotherapy; Radiosurgery