Pineal choriocarcinoma
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Synonyms and keywords: Pineal embryonal cell carcinoma; Pineal gland tumor; Brain tumor
Overview
- Pineal choriocarcinoma is a relatively rare, malignant, highly vascular neoplasm and accounts for a small proportion of all intracranial germ cell tumors. It is an aggressive tumor and has a propensity to metastasise systemically. Pure pineal choriocarcinoma tumors secrete β-HCG.[1]
- On microscopic histopathological analysis, pineal choriocarcinoma is characterized by presence of intimately related syncytiotrophoblasts and cytotrophoblasts without formation of definite placental type villi. Syncytiotrophoblasts are large multi-nucleated cells with eosinophilic cytoplasm. They often surround the cytotrophoblasts, reminiscent of their normal anatomical relationship in chorionic villi. Cytotrophoblasts are polyhedral, mononuclear cells with hyperchromatic nuclei and a clear or pale cytoplasm.[2]
- Pineal choriocarcinoma accounts for 5% of all pineal masses and 10% of all intracranial germ cell tumors.[1]
- The peak age at diagnosis for pineal choriocarcinoma is 20-30 years.
- Common complications of pineal choriocarcinoma include:[3][4]
- CSF metastasis
- Ventricular hemorrhage
- Coma
- Systemic metastasis
- The clinical presentation of pineal choriocarcinoma is mainly from the obstructive hydrocephalus secondary to compression of the tectum of the midbrain and obstruction of the aqueduct. Symptoms of pineal choriocarcinoma include headache, vomiting, ptosis, and weakness.[5]
- Compression of the superior colliculi can lead to a characteristic gaze palsy, known as Parinaud syndrome.
- Common physical examination findings of pineal choriocarcinoma include papilledema, signs of precocious puberty, restricted extraocular movements, sluggish pupillary light reflex, stiff neck, hemiparesis, and abducent nerve palsy.[5]
- Laboratory findings consistent with the diagnosis of pineal choriocarcinoma include abnormal CSF analysis, demonstrating xanthochromia.[5]
- On head CT scan, pineal choriocarcinoma is characterized by a round, calcified, homogeneous, enhancing mass in the third ventricle. Periventricular lucency with marked dilatation of the lateral and third ventricles may be observed.<ref name="FujiiItakura1981">Fujii, Toru; Itakura, Toru; Hayashi, Seiji; Komai, Norihiko; Nakamine, Hirokazu; Saito, Koji (1981). "Primary pineal choriocarcinoma with hemorrhage monitored by computerized tomography". Journal of Neurosurgery. 55 (3): 484–487. doi:10.3171/jns.1981.55.3.0484. ISSN 0022-3085.</ref
References
- ↑ 1.0 1.1 Intracranial choriocarcinoma. Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/intracranial-choriocarcinoma. Accessed on December 7, 2015
- ↑ Pathology of choriocarcinoma. Wikipedia 2015. https://en.wikipedia.org/wiki/Choriocarcinoma. Accessed on December 7, 2015
- ↑ Kida Y, Banno M, Kanzaki M, Kobayashi T, Kageyama N (1985). "[Pineal choriocarcinoma presenting massive ventricular hemorrhage--a case report]". No Shinkei Geka. 13 (6): 641–5. PMID 3840234.
- ↑ Radiographic features of intracranial choriocarcinoma. Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/intracranial-choriocarcinoma. Accessed on December 7, 2015
- ↑ 5.0 5.1 5.2 Fujii, Toru; Itakura, Toru; Hayashi, Seiji; Komai, Norihiko; Nakamine, Hirokazu; Saito, Koji (1981). "Primary pineal choriocarcinoma with hemorrhage monitored by computerized tomography". Journal of Neurosurgery. 55 (3): 484–487. doi:10.3171/jns.1981.55.3.0484. ISSN 0022-3085.