title: Increased mitotic and proliferative activity are associated with worse prognosis in papillary tumors of the pineal region.
abstract: Papillary tumors of the pineal region are rare glial tumors located in the vicinity of the third ventricle, the clinical behavior of which is often aggressive. Little is known about the prognostic markers that might aid to identify patients at increased risk for recurrence. Therefore, the prognostic value of histopathologic and clinical features was examined in a series of 21 patients. Median age of the 12 male and 9 female patients was 35 years (range, 10 to 56 y). On histopathologic examination, all tumors were characterized by loose papillary structures and tumor cells forming broad perivascular pseudorosettes showing cytokeratin expression. In addition, tumors showed increased cellularity (n=4; 19%), nuclear pleomorphism (n=4; 19%), solid growth (n=11; 52%), necrosis (n=8; 38%), increased mitotic activity (≥3 mitoses per 10 high-power fields [n=10; 48%]), and increased proliferation (Ki67/MIB1 index ≥10% [n=8/20; 40%]). Gross total resection could be achieved in 13/21 patients (62%). Postoperatively, 13 patients received radiotherapy and 4 patients chemotherapy. Median recurrence-free survival was 66 months in 19 patients, for whom detailed follow-up information was available. Twelve patients (63%) experienced tumor progression. Three patients (16%) died of disease. Among the clinical and histopathologic features examined, only increased mitotic activity (52 [8 to 96] vs. 68 [66 to 70] mo [median [95% confidence interval]]) and proliferative activity (29 [0 to 64] vs. 67 [44 to 90] mo) were significantly associated with recurrence (P<0.05). Tumors of the 3 patients who had succumbed to disease showed increased mitotic and proliferative activity. In conclusion, increased mitotic and proliferative activities are associated with worse prognosis in papillary tumors of the pineal region.
authors.affiliation: *Institute of Neuropathology, University Hospital Münster, Münster †Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen ‡Institute of Neurology (Edinger Institute), Goethe University, Frankfurt §Institute of Pathology and Neuropathology, University Hospital Essen, Essen ∥Department of Neuropathology, Regensburg University Hospital, Regensburg #Department of Neuropathology, Institute of Pathology, Hannover Medical School, Hannover **Institute of Neuropathology, Justus Liebig University, Giessen ††Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany ¶Department of Clinical Pathology, Section of Neuropathology, Institute of Pathology, University of Bern, Bern, Switzerland.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Heim
authors.forename: Rudi
authors.initials: R
authors.lastname: Beschorner
authors.forename: Michel
authors.initials: M
authors.lastname: Mittelbronn
authors.forename: Kathy
authors.initials: K
authors.lastname: Keyvani
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Riemenschneider
authors.forename: Istvan
authors.initials: I
authors.lastname: Vajtai
authors.forename: Christian
authors.initials: C
authors.lastname: Hartmann
authors.forename: Till
authors.initials: T
authors.lastname: Acker
authors.forename: Ingmar
authors.initials: I
authors.lastname: Blümcke
authors.forename: Werner
authors.initials: W
authors.lastname: Paulus
authors.forename: Martin
authors.initials: M
authors.lastname: Hasselblatt
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D049109:Cell Proliferation; D002648:Child; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008938:Mitosis; D008940:Mitotic Index; D010212:Papilloma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D010870:Pineal Gland / Q000473:pathology* / Q000601:surgery; D010871:Pinealoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D055815:Young Adult