Papillary tumor of the pineal region case reports [Neurosurgery Wiki]

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====== Papillary tumor of the pineal region case reports ======

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A case of PTPR in a 9-year-old girl who presented with a 5-month history of excessive appetite and weight gain. The patient underwent neuroimaging procedures and total gross surgical resection with postoperative adjuvant local radiotherapy, which from our experience was the best treatment choice as an attempt to avoid local recurrence. During 78-month follow-up, the patient from our study manifested no disease recurrence.

Conclusion: PTPR should be included in the differential diagnosis of pineal region masses
((Nemir J, Maric LS, Trbojevic T, Zarkovic K, Jadrijević-Cvrlje F. Papillary tumor of the pineal region in pediatric patient - A case report. Surg Neurol Int. 2022 Oct 28;13:488. doi: 10.25259/SNI_867_2022. PMID: 36447897; PMCID: PMC9699836.)).
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A 3-year-old boy who was re-operated for a recurrent PTPR (grade II). The gross total resection of the lesion, through an occipital [[interhemispheric approach]] in [[sitting position]], was followed by adjuvant [[radiochemotherapy]]. Histological examination revealed tumor progression (grade III), and the MIB-1 proliferation index was higher than 25%. The patient continues to do well with no evidence of recurrence more than 3 years following surgery. A comprehensive literature review regarding the PTPR, including the current management in children, is reported. PTPR are extremely rare in children, and immunohistochemistry is needed for their differentiation from other [[pineal tumor]]s. These tumors present a big rate of recurrence, and a multidisciplinary management (microsurgical resection followed by radio- and/or chemo-therapy) is needed in most of the cases to achieve favorable outcomes
((Choque-Velasquez J, Colasanti R, Resendiz-Nieves J, Jahromi BR, Tynninen O,
Collan J, Niemelä M, Hernesniemi J. Papillary tumor of the pineal region in
children: presentation of a case and comprehensive literature review. World
Neurosurg. 2018 Jun 12. pii: S1878-8750(18)31235-X. doi:
10.1016/j.wneu.2018.06.020. [Epub ahead of print] Review. PubMed PMID: 29906576.
)).
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A 34-year-old male with headaches, [[blurred vision]] and normal examination. Radiological study showed a nodulocystic lesion in the pineal region compatible with [[pineocytoma]]. Surgery was performed using an [[infratentorial supracerebellar approach]], finding a cystic tumor in the [[quadrigeminal cistern]] which was completely resected. Histopathology reported a papillary tumor of the pineal region. The patient made good progress without adjuvant therapy, and after 57 months of follow-up he remained asymptomatic and free of [[recurrence]]
((Cañizares Méndez MA, Amosa Delgado M, Álvarez Salgado JA, Villaseñor Ledezma
JJ, Capilla Cabezuelo E, Díaz Crespo F. Papillary tumor of the pineal region:
Case report and review of the literature. Neurocirugia (Astur). 2018 Apr 21. pii:
S1130-1473(18)30029-0. doi: 10.1016/j.neucir.2018.03.003. [Epub ahead of print]
English, Spanish. PubMed PMID: 29691144.
)).
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The first case of stereotactic radiosurgery of a histologically confirmed papillary tumor of the pineal region.

After establishing the diagnosis by stereotactic biopsy, the patient was treated with stereotactic radiosurgery in a Gamma Knife unit.

Five years after treatment, the tumor size is still decreasing, showing a good response to the treatment.

Stereotactic radiosurgery should be considered a treatment option for these surgically challenging tumors
((Riis P, van Eck AT, Dunker H, Bergmann M, Börm W. Stereotactic radiosurgery of a papillary tumor of the pineal region: case report and review of the literature. Stereotact Funct Neurosurg. 2013;91(3):186-9. doi: 10.1159/000344023. Epub 2013 Feb 27. PMID: 23446182.))