title: Endoscopic Histologic Mapping of a Mixed Germ Pineal Tumor.
abstract: BACKGROUND
  The accurate histologic diagnosis of germ cell tumors in the pineal region is a keystone for determining the best treatment strategy and prognosis. This situation poses a challenge for the neuropathologist, considering the lack of a standarized procedure to obtain biopsy samples, which results in few and small specimens, which are not suitable for diagnosis.
  
  
  METHODS
  We report a case in which a pineal region mixed germ cell tumor was accurately diagnosed by performing histologic mapping through a dual burr-hole endoscopic approach. The technical pitfalls and other considerations necessary for obtaining an accurate diagnosis in this tumor subgroup are specified. In addition, the histologic analysis regarding the sampling technique used is described.
  
  
  CONCLUSIONS
  The supraorbital frontal endoscopic approach enables the surgeon to perform histologic mapping of pineal region tumors, allowing standarization of the procedure used to obtain the specimens. This approach could result in a more accurate diagnosis, especially in mixed germ cell neoplasms.
authors.affiliation: Department of Neurological Surgery and Spine Unit, Hospital Universitario Marqués de Valdecilla and Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Velásquez
authors.affiliation: Department of Neurosurgery, Hospitales Universitarios Virgen del Rocio, Seville, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Rivero-Garvía
authors.affiliation: Department of Pathology, Hospitales Universitarios Virgen del Rocio, Seville, Spain.
authors.forename: Eloy
authors.initials: E
authors.lastname: Rivas
authors.affiliation: Department of Pediatric Anesthesiology, Hospitales Universitarios Virgen del Rocio, Seville, Spain.
authors.forename: María de Los Angeles
authors.initials: ML
authors.lastname: Cañizares
authors.affiliation: Department of Neurosurgery, Complejo Hospitalario de Toledo, Toledo, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Mayorga-Buiza
authors.affiliation: Department of Neurosurgery, Hospitales Universitarios Virgen del Rocio, Seville, Spain. Electronic address: jaca5@arrakis.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Márquez-Rivas
mesh_terms: D000293:Adolescent; D001706:Biopsy; D018240:Endodermal Sinus Tumor / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D018237:Germinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D018193:Neoplasms, Complex and Mixed / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D044583:Neuroendoscopy / Q000379:methods; D010871:Pinealoma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D013724:Teratoma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Biopsy; Disgerminoma; Endoscopy; Pineal tumor; Ventriculostomy; Yolk sac