title: Increased VEGF levels in a case of papillary tumor of the pineal region with intracranial hemorrhage: a potential surrogate indicator of tumor angiogenesis and aggressiveness?
abstract: Pineal tumors are rare, about 1% of all intracranial tumors. At variance with pineocytomas, usually characterized by a good prognosis, papillary tumors behave more aggressively. Owing to their rarity, little is known about their biology and clinical behavior, moreover conflicting data on prognosis have been reported. Here we present an unusual case of papillary neuroepithelial tumor of the pineal region in a 40-year-old man who was admitted in a state of unconsciousness due to the presence of intracranial hemorrhage. After 21 days from admission, he underwent third ventriculostomy for hydrocephalus and biopsy of the lesion. Since bleeding manifestations are uncommonly associated with this kind of tumors, we performed some additional non routine laboratory tests in order to identify biological indicators of disease course and abnormal angiogenesis. Coagulation screening tests were performed to rule out the presence of coagulopathy and vascular endothelial growth factor (VEGF ) levels were measured in plasma as marker of tumor angiogenic potential. Histologic evaluation confirmed the diagnosis of a papillary tumor of the pineal region with the presence of tiny vessel lumens that may account for increased angiogenesis Coagulation screening was normal and VEGF levels were extremely high if compared to healthy individuals. After 20 months of follow-up the tumor mass, radiotherapy treated, appeared dramatically reduced at MRI evaluation, and, interestingly, VEGF levels, although still higher than in healthy individuals, resulted significantly decreased as compared to those measured at time of first hospital admission suggesting a role for VEGF as indicator of tumor aggressiveness. In conclusion, measurement of angiogenesis circulating soluble markers could have an additional feedback in the diagnosis, therapy and monitoring the disease in patients with very rare CNS tumors as papillary tumors of pineal region that have non univocal clinical behavior and prognosis.
authors.affiliation: Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, University of Milan, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marfia
authors.affiliation: Neurosurgery Unit, San Carlo Borromeo Hospital, Milan, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Ampollini
authors.affiliation: Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, University of Milan, Milan, Italy.
authors.forename: Stefania E
authors.initials: SE
authors.lastname: Navone
authors.affiliation: Department of Medical Biotechnology and Translational Medicine, Interdisciplinary Lab of Advanced Technologies (LITA), University of Milan, Segrate, Milan, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Di Vito
authors.affiliation: Department of Pathology, San Carlo Borromeo Hospital, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bornati
authors.affiliation: Division of Pathology, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, University of Milan, Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Miozzo
authors.affiliation: Department of Pathology, San Carlo Borromeo Hospital, Milan, Italy.
authors.forename: Gisele
authors.initials: G
authors.lastname: De Rezende
authors.affiliation: Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, University of Milan, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Rampini
authors.affiliation: Department of Medical Biotechnology and Translational Medicine, Interdisciplinary Lab of Advanced Technologies (LITA), University of Milan, Segrate, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Riboni
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, Milan, Italy.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Mancuso
authors.affiliation: Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, University of Milan, Milan, Italy - rolando.campanella@unimi.it.
authors.forename: Rolando
authors.initials: R
authors.lastname: Campanella
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology*; D008297:Male; D018302:Neoplasms, Neuroepithelial / Q000097:blood / Q000150:complications / Q000473:pathology*; D009389:Neovascularization, Pathologic / Q000097:blood / Q000473:pathology*; D010871:Pinealoma / Q000097:blood / Q000150:complications / Q000473:pathology*; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*
chemical_list: D014408:Biomarkers, Tumor; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A