Pinealoblastomas in children.
BACKGROUND
Series of pinealoblastomas (PB) usually comprise small number of cases as this tumor type is extremely rare and occurs mainly in childhood (especially under 9 years of age). Frequently, PB are reported together with others pineal parenchymal tumors (PPT) or pineal tumors, making characterization far from adequate.


METHODS
Our series of CNS pediatric tumors comprises 1,350 cases of whom 16 are PPT, 12 PB, two pineocytomas (PC), and two mixed or transitional tumors (PC/PB). We have only analyzed the PB considering clinical features, treatment strategy, prognosis, recurrences, and mortality.


RESULTS
PB represented 0.89%. Mean age was 7 years. Male-female ratio was 8/4. All patients complained of increased intracranial pressure, eight presented ocular symptoms, two cerebellar, and one endocrine disturbances. Patients underwent CT scans and/or MRI. All children had negative serum and CSF markers and only one case had positive tumor cells in the CSF on admission. Hydrocephalus (12/12) was treated with ventriculoperitoneal shunt in 11/12 and endoscopic third ventriculostomy (ETV) in 1/12. We performed 11 surgical procedures (seven by occipital transtentorial approach) and one endoscopic biopsy. Total removal was achieved in two, partial removal (50-90%) in seven, and biopsy in three patients or <50%. Adjuvant therapy included radiotherapy and chemotherapy. Recurrences appeared in 8/12 cases (mean time of recurrence=27.28 months). Six patients died (mean survival=29.55 months). Mean follow up for the six patients alive was 54 months and mean follow up for all 12 children was 38.7 months.


CONCLUSIONS
In our opinion, PB have a poor prognosis and are very aggressive, especially in small children. Survival rate at 1 and 5 years in the present series is 66.6% (8/12) and 50% (6/12), respectively. We propose an algorithm for the treatment of pediatric patients with PB.
Unit of Pediatric Neurosurgery, Hospital Nacional de Pediatría, "Prof. Juan P. Garrahan", Combate de los Pozos 1881, 1245, Capital Federal, Buenos Aires, Argentina. vcuccia@fibertel.com.ar
Vicente
V
Cuccia
Facundo
F
Rodríguez
Fernando
F
Palma
Graciela
G
Zuccaro
D000293:Adolescent; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010870:Pineal Gland / Q000473:pathology* / Q000601:surgery; D010871:Pinealoma / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt / Q000379:methods*