Abstract
We present a case of an 82-year-old female with a pineal parenchymal tumor of intermediate differentiation (PPTID). She underwent endoscopic third ventriculostomy and endoscopic biopsy of the tumor with resolution of her presenting symptoms. Because of her age and comorbidities, she was treated with CyberKnife stereotactic radiosurgery. This is the oldest patient with PPTID that has been reported and is the first reported case treated with CyberKnife radiosurgery.
Highlights
Pineal parenchymal tumors (PPT) are rare neoplasms of the pineal gland which constitute less than 0.3% of all intracranial tumors [1]
More recently described are papillary tumors of the pineal region (PTPR), which appear histologically distinct from PPTs and may represent a different cell of origin or an extension of the continuum of PPTs [3,4]
We describe an 82year-old patient with pineal parenchymal tumor of intermediate differentiation (PPTID) treated with endoscopic third ventriculostomy, endoscopic biopsy, and CyberKnife radiosurgery
Summary
Pineal parenchymal tumors (PPT) are rare neoplasms of the pineal gland which constitute less than 0.3% of all intracranial tumors [1]. By the time of her first follow-up appointment one month from surgery, the patient showed significant improvement in her mental status and was noted to be fully oriented with improved strength, balance, and ability to ambulate independently. She reportedly had only mild difficulty with processing tasks (e.g. playing solitaire), but was otherwise markedly better than on admission. The tumor was positive for synaptophysin and chromogranin, negative for CKMIX, and showed Ki-67 positivity of 510% These features are consistent with the diagnosis of pineal parenchymal tumor of intermediate differentiation (PPTID), WHO Grade II-III (Figure 3). The patient tolerated the CyberKnife treatment with no adverse effects
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