Abstract
A 10-year-old boy with no past medical history presented with complaints of nausea and vomiting associated with morning headache for the last month. Ophthalmic nerve and eye exam showed diplopia and strabismus with no other significant findings on physical and neurological examination. Magnetic resonance imaging (MRI) of the brain revealed a homogenous hyperdense and enhancing mass in the pineal region. The endoscopic biopsy of the pineal region demonstrated the cells with highly pleomorphic and hyperchromatic nuclei with an increase in mitotic activity. There were many vessels but no area of vascular proliferation and necrosis. Granular bodies with eosinophilia were identified. Immunohistochemistry was positive for class III b-tubulin with epidermal growth factor receptor (EGFR) staining and glial fibrillary acidic protein (GFAP). Immunostaining was positive for p53, Phosphatase and Tensin homolog (PTEN), and oligodendrocyte transcription factor (OLIG2), while staining for cluster of differentiation (CD)34, cytokeratin (CK), human melanoma black (HMB)45, and isocitrate dehydrogenase (IDH)-R132H mutation was negative, consistent with atypical pleomorphic neoplasm of the pineal region. The patient underwent tumor resection via a sub-occipital trans-tentorial approach, followed by one dose of chemotherapy. The patient experienced a resolution of the symptom and was doing well on his bi-monthly follow up.
Highlights
Pineal gland tumors contribute to less than 1% of all the primary brain tumors in Europe and North America
Immunohistochemistry was positive for class III b-tubulin with epidermal growth factor receptor (EGFR) staining and glial fibrillary acidic protein (GFAP)
We present a case of a child with an atypical pleomorphic neoplasm of the pineal gland
Summary
Pineal gland tumors contribute to less than 1% of all the primary brain tumors in Europe and North America They are more common in Asian countries and among the one- to 12-year age group (3% of brain tumors) [1,2]. We present a case of a child with an atypical pleomorphic neoplasm of the pineal gland. The patient was healthy and appeared oriented and alert with intact cognition His skin, extremities, and pulses were normal. The sensation was intact bilaterally, and the reflexes were intact on both sides of the body His cranial nerve examination was unremarkable except ophthalmic nerve and eye examination. The patient underwent endoscopic biopsy of the pineal region, which demonstrated cells with highly pleomorphic and hyperchromatic nuclei. The patient experienced a resolution of the symptom and was doing well on his bi-monthly follow up
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