BACKGROUND: Tumors of the pineal gland are relatively rare. Most are solid, infiltrative lesions characterized by either germ cell, glial, or pineal parenchymal origin. To our knowledge, none have been described that contain an admixture of both anaplastic glial and neuronal elements. CASE REPORT: The authors present a case of a primary anaplastic glio-neuronal tumor of the pineal gland in a 78-year-old gentleman who presented with hydrocephalus. The patient underwent an endoscopic third ventriculostomy for treatment of his hydrocephalus as well as tumor biopsy under endoscopic visualization. RESULTS: Sections of the tumor displayed a modestly to moderately cellular neoplasm infiltrating the residual pineal gland. The majority of the nuclei appeared hyperchromatic, spindle-shaped, and pleomorphic, with fibrillary cytoplasmic processes. Rare nuclei were round with vesicular chromatin and red nucleoli. Mitotic figures were easily identified, despite small sample size. GFAP immunostaining highlighted the fibrillar background and cytoplasmic processes while synaptophysin immunostains revealed intense, dot-like positivity in the rounder nuclei with vesicular chromatin. Although the different nuclear morphologies seen on the hematoxylin-eosin stained slides suggested both glial and neuronal origin, immunostains were required to confirm the presence of dual differentiation. CONCLUSION: We present the first case of a primary anaplastic glio-neuronal neoplasm of the pineal gland. Increased use of immunostaining may unveil additional cases in the future. Furthermore, additional research will be required to determine whether the dual differentiation has prognostic significance.
BACKGROUND: Tumors of the pineal gland are relatively rare. Most are solid, infiltrative lesions characterized by either germ cell, glial, or pineal parenchymal origin. To our knowledge, none have been described that contain an admixture of both anaplastic glial and neuronal elements. CASE REPORT: The authors present a case of a primary anaplastic glio-neuronal tumor of the pineal gland in a 78-year-old gentleman who presented with hydrocephalus. The patient underwent an endoscopic third ventriculostomy for treatment of his hydrocephalus as well as tumor biopsy under endoscopic visualization. RESULTS: Sections of the tumor displayed a modestly to moderately cellular neoplasm infiltrating the residual pineal gland. The majority of the nuclei appeared hyperchromatic, spindle-shaped, and pleomorphic, with fibrillary cytoplasmic processes. Rare nuclei were round with vesicular chromatin and red nucleoli. Mitotic figures were easily identified, despite small sample size. GFAP immunostaining highlighted the fibrillar background and cytoplasmic processes while synaptophysin immunostains revealed intense, dot-like positivity in the rounder nuclei with vesicular chromatin. Although the different nuclear morphologies seen on the hematoxylin-eosin stained slides suggested both glial and neuronal origin, immunostains were required to confirm the presence of dual differentiation. CONCLUSION: We present the first case of a primary anaplastic glio-neuronal neoplasm of the pineal gland. Increased use of immunostaining may unveil additional cases in the future. Furthermore, additional research will be required to determine whether the dual differentiation has prognostic significance.