2025 Poster Presentations
P328: CASE REPORT: PAPILLARY TUMOR OF THE PINEAL REGION (PTRP)
Mateus N Reghin, Neurosurgeon1; Heros M Almeida, Neurosurgeon2; Matheus F Lourenço, DDS3; 1Instituto de Ciências Neurologicas, Beneficiencia Portuguesa, Servidor Publico; 2Instituto de Ciências Neurologicas, Beneficiencia Portuguesa; 3Ac Camargo Cancer Center
Identification and Clinical History: Patient: R.N., male, 29 years old. Symptoms: Intense, progressive headache for 9 months. Initial Diagnosis: Expansive formation in the pineal region, obstructive hydrocephalus.
Imaging Exams: MRI revealed a solid expansive formation in the pineal region (2.2 x 1.9 cm), obstruction of the aqueduct of Sylvius, and hydrocephalus.
Surgical Intervention: Date: 05/30/2016.
Procedure: Median suboccipital craniotomy, micro-surgical resection, and decompression of the cerebral aqueduct.
Postoperative Evolution: Control MRI: No residual lesion, no ischemia, or hemorrhage. Recovery: Normalized motor coordination, inconsistent visual improvement, progression of ocular plegia.
Anatomopathological Exams: Macroscopy: Irregular fragments (4.1 x 1.8 x 0.7 cm), white-yellowish surfaces with brownish areas. Microscopy: Hypercellular neoplasm, papillary arrangement, necrosis, and calcification foci. Immunohistochemistry: Positive for S-100, synaptophysin, cytokeratins, Ki-67 (20-25%); negative for GFAP, EMA, and neurofilament.
Diagnosis: Papillary tumor of the pineal region (ICD D33.1).
Recurrence: After four years, the patient presented with a recurrence of the lesion. A new surgery was indicated, but the patient opted for radiotherapy. Two years later, there was progression of the lesion, requiring reoperation. The outcome of the operation was satisfactory, with resection of the bilateral thalamic region. Bilateral signal area in the thalamus is observed, possibly due to the applied therapy.
Discussion: Papillary tumor of the pineal region (PTPR) is a rare neoplasm with specific histopathological and immunohistochemical characteristics. Early surgical treatment and continuous monitoring are essential for proper management.
Conclusion: Early diagnosis and surgical management are fundamental for disease control and clinical improvement. Continuous neurological follow-up is crucial to monitor recurrences and complications.