Pineal parenchymal tumor of intermediate differentiation – case report

Autor: Dora Gašparini, Dinko Štimac, Andrea Dekanić, Nives Jonjić
Rok vydání: 2018
Předmět:
Zdroj: Medicina Fluminensis : Medicina Fluminensis
Volume 54
Issue 4
ISSN: 1847-6864
1848-1868
1848-820X
DOI: 10.21860/medflum2018_207361
Popis: Cilj: Prikazati slučaj pacijentice s pinealnim parenhimnim tumorom intermedijarnog stupnja diferencijacije gradus II, s naglaskom na patohistološku dijagnozu ovog kliničkog entiteta. Prikaz slučaja: Tridesetosmogodišnja pacijentica primljena je na Kliniku za neurokirurgiju Kliničkog bolničkog centra Rijeka radi operativnog liječenja ciste pinealne regije. Osnovni i jedini simptomi bile su glavobolje unatrag četiri godine. Magnetska rezonanca mozga ukazivala je na cističnu tvorbu pinealne regije. Učinjena je osteoklastična subokcipitalna medijana kraniotomija s ekstirpacijom ciste pinealne regije te je bioptički uzorak poslan na patohistološku analizu. Histološki je utvrđeno oskudno tkivo mozga infiltrirano umjereno celularnim tumorskim tkivom građenim od difuzno raspoređenih, malih uniformnih stanica oskudne citoplazme s tendencijom stvaranja perivaskularnih acelularnih područja i diskretnim pineocitomatoznim rozetama. Jezgre tumorskih stanica bile su ovalne, monomorfnog izgleda s mjestimičnom blagom polimorfijom. Mitotska aktivnost bila je niska i iznosila je manje od 0,5%. U bioptičkom uzorku bilo je nekoliko manjih žarišta kalcifikacije, ali bez prisustva nekroze. Imunohistokemijska analiza pokazala je izrazitu difuznu obojenost na neuron specifičnu enolazu (engl. neuron-specific enolase, NSE) i znakove neuroendokrine diferencijacije o čemu svjedoči snažna difuzna obojenost na sinaptofizin. Na temelju histološke slike i imunohistokemijskog profila zaključeno je da pregledani materijal predstavlja pinealni parenhimni tumor intermedijarnog stupnja diferencijacije - WHO gradus II. Pacijentica se nakon operacije osjećala dobro i otpuštena je na kućno liječenje. Zaključci: Jedino ispravno postavljena patohistološka dijagnoza može dovesti do odgovarajućeg izbora terapije i ispravnog kliničkog pristupa bolesniku s pinealnim parenhimnim tumorom intermedijarnog stupnja diferencijacije. Daljnja molekularna istraživanja bila bi od koristi patologu u postavljanju standarda i izradi smjernica, koje bi pomogle u postavljanju točne dijagnoze.
Aim: To report a case of a patient with the pineal parenchymal tumor of intermediate differentiation grade II, with emphasis on histopathological diagnosis of this clinical entity. Case report: A 30-year-old patient was admitted at the Clinic for Neurosurgery within the Clinical Hospital Centre Rijeka in order to surgically remove a cyst in the pineal region. The only and main symptoms were headaches in the past four years. Magnetic resonance was performed to visualize the pineal cyst. Osteoclastic suboccipital median craniotomy with extirpation of the cyst had been done and the biopsy specimen was sent to the Pathology Department of the Clinical Hospital Centre Rijeka. Histologically, the tissue of the brain was infiltrated by a moderately cellular tumor tissue consisting of diffusely distributed small uniform cells with scarce cytoplasms and with the tendency to form perivascular acellular areas with discrete pineocytomatous rosettes. Nuclei of the tumor cells were oval and monomorphic with an occasional mild polimorphism. Mitotic activity was low and measured less than 0,5%. The biopsy specimen included several smaller foci of calcification without the presence of necrosis. Immunohistochemistry showed strong diffuse positivity for neuron-specific enolase and synaptophysin, which suggests neuroendocrine differentiation. According to the histological findings and immunohistochemistry profile the pineal parenchymal tumor of intermediate differentiation - WHO gradus II has been diagnosed. The patient was feeling well after the operation and had been dismissed for further home treatment. Conclusions: Only precisely determined histopathological diagnosis will result in adequate choice of therapy and accurate clinical approach to any patient with this type of tumor. Further molecular research needs to be conducted in order to form standardized guidelines which would help in process of confirming the exact diagnosis.
Databáze: OpenAIRE
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