Pineal region tumors in children: is gross-total resection necessary? A single-center experience

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Enrique López-Aguilar
María del Carmen Garza-González
Mariana Ortiz-Azpilcueta
Ana Carolina Sepúlveda-Vildósola
Ana Rioscovian-Soto
Hermilo De la Cruz-Yáñez
Yadira Betanzos-Cabrera

Keywords

Pineal neoplasms, Neuroendocrine tumors

Abstract

Background: Survival of children with pineal region tumors has increased  significantly in the last decade; these tumors have an insidious outcome associated with endocrine disorders with high morbidity and mortality, especially after gross resection. The objective was to report the survival, outcome, morbidity and mortality according to type of surgery, histology and treatment in children with pineal region tumors. 

Methods: This retrospective study included all patients of 17 years or less with diagnosis of pineal region tumor, who went over a period of 10 years to a children’s hospital. A histopathological review was made, and the extent of resection was determined. The survival was also estimated.

Results: Forty-six patients were included, out of which 36 had complete medical records and adequate pathologic material. Gross resection was performed in 24 (66.6 %), and biopsy in 12 (33.3 %); 23 (88 %) patients died; hydroelectrolytic imbalance was the cause of 14 deaths (60 %) and the other nine (39.1 %) were secondary to tumor progression. Ten-years survivals among patients treated with gross resection and biopsy were 52 and 75 %, respectively (p = 0.7). Endocrine alterations were observed in 13 patients (36.1 %); in 10 of these (76.9 %) the total resection was performed.

Conclusion: Pineal region tumors in children can be treated with diagnostic biopsy, followed by adjuvant treatment consisting of chemotherapy and radiotherapy.

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References

Gillheeney SW, Saad A, Chi S, Turner C, Ullrich NJ, Goumnerova L, et al. Outcome of pediatric pineoblastoma after surgery. J Neurooncol 2008;89(1):89-95.

 

Yazici N, Varen A, Söylemezoğlu F, Zorlu F, Kutluk T, Akyüz C, et al. Pineal region tumors in children: a single center experience. Neuropediatrics. 2009;40(1):15-21.

 

Navas-García M, Goig-Revert F, Villarejo-Ortega FJ, Robla J, de Prada I, Madero L et al. Tumores de la región pineal en la edad pediátrica. Presentación de 23 casos y revisión de la bibliografía. Rev Neurol. 2011;52(11)641-52.

 

Kumar P, Tatke M, Sharma A, Singh D. Histological analysis of lesions of the pineal region: a retrospective study of 12 years. Pathol Res Pract. 2006;202(2):85-92.

 

Cho BK, Wang KC, Nam DH, Kim DG, Jung HW, Kim HJ. Pineal tumors: experience with 48 cases over 10 years. Childs Nerv Syst .1998;14(1-2):53-8.

 

Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemoter Rep. 1966 Mar;50(3):163-70.

 

Echeverria M, Fangusaro J, Goldman S. Pediatric central nervous system germ cell tumors: a review. Oncologist 2008;13(6):690-9.

 

Ray P, Jallo GI, Kim RY, Kim BS, Wilson S, Kothbauer K, et al. Endoscopic third ventriculostomy for tumor related hydrocephalus in a pediatric population. Neurosurg Focus. 2005;19(6):E28.

 

Sawamura Y, de Tribolet N, Ishii N, Abe H. Management of primary intracranial germinomas: Diagnostic surgery or radical resection. J Neuroeurg. 1997;87(2):262-6.

 

Balmaceda C, Finlay J. Current advances in the diagnosis and management of intracranial germ cell tumors. Curr Neurol Neurosci Rep. 2004;4(3):253-62.

 

Packer RJ. Cohen BH, Cooney K. Intracraneal germ cell tumors. Oncologist. 2000;5(4):312-20.

 

Jubran RF, Finlay J. Central nervous system germ cell tumors. controversies in diagnosis and treatment. Oncology (Williston Park). 2005; 19(6):705-11.

 

Cho BK, Wang KC Nam DH, Kim DG, Jung HW, Kim HJ, et al. Pineal tumors, experience with 48 cases over 10 years. Child Nerv Syst. 1998;14(1):53-8.

 

Kang JK, Jeun SS, Hong YK, Park CK, Son BC, Lee IW. Experience with Pineal region tumors. Childs Nerv Syst. 1998;14(1-2):63-8.

 

Al Hussaini M, Sultan Iyad, Abuirmileh N. Pineal gland tumors: experience from the SEER database. J Neurooncol. 2009; 94(3):351-8. Texto libre http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804886/

 

Brat DJ, Parisi JE, Kleinschmidt-DeMasters BK, Yachnis AT, Montine TJ, Boyer PJ, et al. Surgical neuropathology update. a review of changes introduced by the WHO classification , 4th edition.. Pathologists 2008; 132(6):993-1007.

 

Konovalov ANPD, Pitskhelauri DI. Principles of treatment of the pineal region tumor. Surg Neurol. 2003;59(4); 250-68.

 

Regis J, Bouillot P, Rouby-Volot F, Figarella-Branger D, Dufour H, Peragut JC.. Pineal region tumors and the role of sterotactic biopsy; review of the mortality and morbidity , and diagnostic rates in 370 cases. Neurosurgery 1996; 39(5):907-12.discussion912-4.

 

Gilles FH, Tavaré CJ, Becker LJ, Burger PC, Yates AJ, Pollack IF,et al. Pathologist interobserver variability of histologic features in childhood brain tumors. results from the CCG-945 study. Pediatr Dev Pathol. 2008; 11(2):108-17.