Malignant pineal region tumors. A clinico-pathological study

E. A. Neuwelt, M. Glasberg, E. Frenkel, W. K. Clark

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Eight patients with primary malignant pineal tumors have been at this institution over the past 6 years, six of them underwent definitive surgical exploration. Complete gross microsurgical excision of well encapsulated tumours was possible in four of these patients. In two cases of pineal germinomas, a biopsy and a subtotal resection were carried out because of the known radiosensitivity of this tumor. These six surgical patients all received postoperative craniospinal radiation and continue to do well up to 6 years postoperatively. Two nonoperative patients were initially treated at other institutions by ventriculoperitoneal shunt and radiation and were the only ones to develop metastatic disease. One patient had metastasis of her pineoblastoma to her unirradiated spinal canal and the other patient had metastasis of his germinoma to the peritoneum. The former patient was quadriplegic on admission, although her pineal tumor was no longer visible on computerized tomography (CT), and she died of pneumonia. The latter patient's tumor secreted the beta chain of human chorionic gonadotropin (HCG). This patient's massive metastatic tumor burden completely regressed as determined by body CT scan and HCG levels after four courses of chemotherapy with bloemycin, vinblastine, and cis-platinum. In 20 patients with lesions of the pineal region, craniotomy was associated with only one death (a patient with metastatic adenocarcinoma). Thus, , microsurgery for pineal tumors provides either a reasonably safe potential for complete tumor extirpation and possible cure, or a tissue diagnosis which is necessary for appropriate therapeutic planning for radiotherapy and/or chemotherapy. The traditional therapeutic approach of empiric radiotherapy without a tissue diagnosis for pineal lesions may no longer be warranted.

Original languageEnglish (US)
Pages (from-to)597-607
Number of pages11
JournalJournal of Neurosurgery
Volume51
Issue number5
StatePublished - 1979

Fingerprint

Pinealoma
Germinoma
Neoplasms
Radiotherapy
Tomography
Radiation
Chorionic Gonadotropin, beta Subunit, Human
Neoplasm Metastasis
Ventriculoperitoneal Shunt
Drug Therapy
Spinal Canal
Microsurgery
Vinblastine
Craniotomy
Radiation Tolerance
Peritoneum
Chorionic Gonadotropin
Tumor Burden
Cisplatin
Pneumonia

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Neuwelt, E. A., Glasberg, M., Frenkel, E., & Clark, W. K. (1979). Malignant pineal region tumors. A clinico-pathological study. Journal of Neurosurgery, 51(5), 597-607.

Malignant pineal region tumors. A clinico-pathological study. / Neuwelt, E. A.; Glasberg, M.; Frenkel, E.; Clark, W. K.

In: Journal of Neurosurgery, Vol. 51, No. 5, 1979, p. 597-607.

Research output: Contribution to journalArticle

Neuwelt, EA, Glasberg, M, Frenkel, E & Clark, WK 1979, 'Malignant pineal region tumors. A clinico-pathological study', Journal of Neurosurgery, vol. 51, no. 5, pp. 597-607.
Neuwelt, E. A. ; Glasberg, M. ; Frenkel, E. ; Clark, W. K. / Malignant pineal region tumors. A clinico-pathological study. In: Journal of Neurosurgery. 1979 ; Vol. 51, No. 5. pp. 597-607.
@article{d2bf7251085c490fa9ae31b6e6e741f4,
title = "Malignant pineal region tumors. A clinico-pathological study",
abstract = "Eight patients with primary malignant pineal tumors have been at this institution over the past 6 years, six of them underwent definitive surgical exploration. Complete gross microsurgical excision of well encapsulated tumours was possible in four of these patients. In two cases of pineal germinomas, a biopsy and a subtotal resection were carried out because of the known radiosensitivity of this tumor. These six surgical patients all received postoperative craniospinal radiation and continue to do well up to 6 years postoperatively. Two nonoperative patients were initially treated at other institutions by ventriculoperitoneal shunt and radiation and were the only ones to develop metastatic disease. One patient had metastasis of her pineoblastoma to her unirradiated spinal canal and the other patient had metastasis of his germinoma to the peritoneum. The former patient was quadriplegic on admission, although her pineal tumor was no longer visible on computerized tomography (CT), and she died of pneumonia. The latter patient's tumor secreted the beta chain of human chorionic gonadotropin (HCG). This patient's massive metastatic tumor burden completely regressed as determined by body CT scan and HCG levels after four courses of chemotherapy with bloemycin, vinblastine, and cis-platinum. In 20 patients with lesions of the pineal region, craniotomy was associated with only one death (a patient with metastatic adenocarcinoma). Thus, , microsurgery for pineal tumors provides either a reasonably safe potential for complete tumor extirpation and possible cure, or a tissue diagnosis which is necessary for appropriate therapeutic planning for radiotherapy and/or chemotherapy. The traditional therapeutic approach of empiric radiotherapy without a tissue diagnosis for pineal lesions may no longer be warranted.",
author = "Neuwelt, {E. A.} and M. Glasberg and E. Frenkel and Clark, {W. K.}",
year = "1979",
language = "English (US)",
volume = "51",
pages = "597--607",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "5",

}

TY - JOUR

T1 - Malignant pineal region tumors. A clinico-pathological study

AU - Neuwelt, E. A.

AU - Glasberg, M.

AU - Frenkel, E.

AU - Clark, W. K.

PY - 1979

Y1 - 1979

N2 - Eight patients with primary malignant pineal tumors have been at this institution over the past 6 years, six of them underwent definitive surgical exploration. Complete gross microsurgical excision of well encapsulated tumours was possible in four of these patients. In two cases of pineal germinomas, a biopsy and a subtotal resection were carried out because of the known radiosensitivity of this tumor. These six surgical patients all received postoperative craniospinal radiation and continue to do well up to 6 years postoperatively. Two nonoperative patients were initially treated at other institutions by ventriculoperitoneal shunt and radiation and were the only ones to develop metastatic disease. One patient had metastasis of her pineoblastoma to her unirradiated spinal canal and the other patient had metastasis of his germinoma to the peritoneum. The former patient was quadriplegic on admission, although her pineal tumor was no longer visible on computerized tomography (CT), and she died of pneumonia. The latter patient's tumor secreted the beta chain of human chorionic gonadotropin (HCG). This patient's massive metastatic tumor burden completely regressed as determined by body CT scan and HCG levels after four courses of chemotherapy with bloemycin, vinblastine, and cis-platinum. In 20 patients with lesions of the pineal region, craniotomy was associated with only one death (a patient with metastatic adenocarcinoma). Thus, , microsurgery for pineal tumors provides either a reasonably safe potential for complete tumor extirpation and possible cure, or a tissue diagnosis which is necessary for appropriate therapeutic planning for radiotherapy and/or chemotherapy. The traditional therapeutic approach of empiric radiotherapy without a tissue diagnosis for pineal lesions may no longer be warranted.

AB - Eight patients with primary malignant pineal tumors have been at this institution over the past 6 years, six of them underwent definitive surgical exploration. Complete gross microsurgical excision of well encapsulated tumours was possible in four of these patients. In two cases of pineal germinomas, a biopsy and a subtotal resection were carried out because of the known radiosensitivity of this tumor. These six surgical patients all received postoperative craniospinal radiation and continue to do well up to 6 years postoperatively. Two nonoperative patients were initially treated at other institutions by ventriculoperitoneal shunt and radiation and were the only ones to develop metastatic disease. One patient had metastasis of her pineoblastoma to her unirradiated spinal canal and the other patient had metastasis of his germinoma to the peritoneum. The former patient was quadriplegic on admission, although her pineal tumor was no longer visible on computerized tomography (CT), and she died of pneumonia. The latter patient's tumor secreted the beta chain of human chorionic gonadotropin (HCG). This patient's massive metastatic tumor burden completely regressed as determined by body CT scan and HCG levels after four courses of chemotherapy with bloemycin, vinblastine, and cis-platinum. In 20 patients with lesions of the pineal region, craniotomy was associated with only one death (a patient with metastatic adenocarcinoma). Thus, , microsurgery for pineal tumors provides either a reasonably safe potential for complete tumor extirpation and possible cure, or a tissue diagnosis which is necessary for appropriate therapeutic planning for radiotherapy and/or chemotherapy. The traditional therapeutic approach of empiric radiotherapy without a tissue diagnosis for pineal lesions may no longer be warranted.

UR - http://www.scopus.com/inward/record.url?scp=0018597779&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0018597779&partnerID=8YFLogxK

M3 - Article

VL - 51

SP - 597

EP - 607

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 5

ER -