Treatment strategy of pineal tumors in consideration of their pathomorphology.

BACKGROUND

Tumors of the pineal gland are rare pathology. This paper reports on therapeutical considerations of histologically heterogeneous pineal tumors in a group of 15 patients and is presenting a special case of neuroaxial seeding.

METHODS

Surgery and/or additional therapeutic procedures were performed in 13 of our 15 patients ("youngster" and "adults") in respect of pathomorphology. Details are reported concerning a 52-year-old man suffering from pineocytoma (WHO grade II), who underwent different kinds of therapy within 10 years follow-up.

RESULTS

In the six "youngster" the histological assessment revealed two teratomas, one mixed pineocytoma/pineoblastoma, one astrocytoma and one epidermoid cyst. All neoplasms were treated surgically with good results. Additional radio-/chemotherapy was used in a case of teratoma and pineocytoma/pineoblastoma. From five successfully surgically treated "adults" (germinoma, pineoblastoma, pineocytoma, two cystic formations) in two of them (germinoma, pineoblastoma) additional radiotherapy was needed, another two patients (cystic formations) were healed after stereotactic puncture. The patient with pineocytoma showed recurrent neuroaxial seeding within 10 years in spite of repeated radiotherapy, though his neurological status remained stable (Karnofsky performance score of 100).

CONCLUSION

Precise histopathological assessment of pineal tumors is essential to guide optimal modern therapy modalities in order to assure a local tumor control. (Fig. 3, Ref. 18.).