Jha Pooja, Shukla Samarth, Vagha Sunita, Acharya Sourya
Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (DMIHER), Wardha, IND.
Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (DMIHER), Wardha, IND.
Cureus. 2023 May 3;15(5):e38495. doi: 10.7759/cureus.38495. eCollection 2023 May.
Pineal tumors are quite rare and are fairly aggressive tumors seen in young adults and children. These tumors arise from the pineal region or recess from various types of cells in the gland and structures located in close propinquity to the gland. Pineal gland tumors have a heterogeneous spectrum that includes pineal parenchymal tumors (PPTs) and papillary tumors of the pineal region (PTPR). The PPTs are further subclassified into pineocytomas (Grade 1), PPTs of intermediate differentiation (grade 2 or 3), and pineoblastomas (grade 4) based on the World Health Organization (WHO) grades and histopathological features. We discuss the case of an 11-year-old male child who presented with complaints of headache for 15 days, vomiting for seven days, and diplopia for four days. On magnetic resonance imaging (MRI), a soft tissue density lesion was noticed in the posterior third ventricle region. Based on the location and the MRI findings, the differential diagnosis considered were a pineal lesion, a choroid plexus papilloma, or a meningioma. He underwent a right occipital ventriculoperitoneal shunt followed by total excision of the tumor, and the resected specimen was sent for histopathological examination. After pathologic examination, the diagnosis of pineoblastoma (grade 4) with features of a PPT of intermediate differentiation (grades 2-3) was revealed, and the same was confirmed on immunohistochemistry.
松果体肿瘤相当罕见，是在年轻人和儿童中发现的侵袭性较强的肿瘤。这些肿瘤起源于松果体区域，或者源自腺体及与腺体紧邻的结构中的各种类型细胞。松果体肿瘤具有异质性，包括松果体实质肿瘤（PPTs）和松果体区域乳头状肿瘤（PTPR）。根据世界卫生组织（WHO）分级和组织病理学特征，PPTs进一步细分为松果体细胞瘤（1级）、中间分化型PPTs（2级或3级）和成松果体细胞瘤（4级）。我们讨论了一名11岁男童的病例，该患儿主诉头痛15天、呕吐7天、复视4天。在磁共振成像（MRI）检查中，发现第三脑室后部区域有一个软组织密度病变。根据病变位置和MRI表现，考虑的鉴别诊断为松果体病变、脉络丛乳头状瘤或脑膜瘤。他接受了右枕部脑室腹腔分流术，随后进行了肿瘤全切，切除标本送组织病理学检查。病理检查后，显示诊断为成松果体细胞瘤（4级），伴有中间分化型PPTs（2 - 3级）的特征，免疫组化结果也证实了这一诊断。
