1/3. Pineal germinoma with granulomatous reaction: case report.A 20-year-old man presented with diplopia. Neurological examination revealed mild skew deviation and upbeat nystagmus. Computed tomography showed a clover-shaped isodense mass in the pineal region with homogeneous enhancement. The lesion was isointense on both T(1)- and T(2)-weighted magnetic resonance (MR) imaging with homogeneous enhancement by gadolinium-diethylenetriaminepenta-acetic acid. cerebral angiography showed no tumor staining. serum and cerebrospinal fluid were negative for beta-human chorionic gonadotropin, alpha-fetoprotein, and placental alkaline phosphatase. Open biopsy was performed using a right occipital transtentorial approach. Histological examination revealed a tumor consisting of clusters of germinoma cells, but with prominent infiltration of lymphocytes, plasma cells, and macrophages, and proliferation of small vessels. The histological diagnosis was germinoma with granulomatous reaction. MR imaging showed complete disappearance of the tumor after chemoradiotherapy. Neurosurgeons should be aware of this rare tumor to avoid misdiagnosis as granulomatous inflammation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/3. Pineocytoma with neuronal differentiation--case report.The authors describe a case of pineocytoma studied by light and electron microscopy and the immunoperoxidase method. The tumor consisted of two types of cells bearing either chromatin-rich or pale nuclei. These cells were arranged in rosettes and contained pale, eosinophilic material at the center, or in lobular patterns with thin connective tissue and a few blood vessels. Bodian silver staining disclosed a delicate tangle of argyrophilic fibers and processes with small, club-like terminations. These findings are characteristic of pineocytoma. On ultrastructural examination, the tumor cells were found to be closely packed, in clumps separated by numerous fine or expanded, interlacing processes, some of which contained microtubules. A few dense core vesicles and clusters of clear vesicles similar to synaptic vesicles were seen, the latter being aggregated around desmosome-like thickenings in the cellular membrane, suggestive of a synaptic complex. Some tumor cells were positive for neuron-specific enolase and S-100 protein. Only a few cells positive for glial fibrillary acidic protein were distributed in the tumor tissue, but it was not ascertained if they were tumor cells or normal, pre-existing astrocytes. The tumor was diagnosed as a pineocytoma with neuronal differentiation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/3. Enhancing meningeal blood vessels masquerading as leptomeningeal spread of tumor in obstructive hydrocephalus.MR showed an enhancing mass in the pineal region and hydrocephalus and leptomeningeal enhancement, thought to indicate pinealoblastoma with leptomeningeal spread. During resection there was no evidence of spread, and repeat MR showed no residual tumor or meningeal enhancement, so the patient was not treated for metastasis. Because there were no signs of leptomeningeal tumor 4 months after surgery, the meningeal enhancement is thought to have been related to venous stasis secondary to obstructive hydrocephalus.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |