It is an honor for having been invited to write a commentary to the published paper
titled, “Recurrent Papillary Tumour of Pineal Region Misdiagnosed as Pineocytoma 9
Years Ago: A Case Report.” The current paper explains the pathological challenge of
pineal tumors which would affect treatment as well. Pathological classification of
brain tumors has evolved during the last decades. Introduction of bio-molecular markers
and new modalities made significant differentiations in pathologies that modified
their treatment and prognosis.
Pineal tumors are challenging type of brain lesions according to their anatomy, surgical
approaches, and pathologic subtypes. Considering pathology, the most common tumors
are pineal parenchymal tumors and germ cell tumors.[[1]] Pineal parenchymal tumors are divided into pineocytoma, pineal parenchymal tumor
with intermediate differentiation, and pineoblastoma. Precise differential diagnosis
is critical for treatment planning.
Papillary tumor of the pineal region (PTPR) is a rare neuro-epithelial tumor categorized
as Grade II or Grade III lesions and resembles a Grade I pineocytoma. Therefore, immunohistochemistry
is essential to differentiate them. Unlike germ cell tumors of pineal region, surgery
seems to be the optimal primary treatment for PTPR to achieve cytoreduction followed
by adjuvant therapies. The current paper emphasizes the role of pathological diagnosis
in a multidisciplinary management of brain tumors. Surgical approach to intracranial
lesions carries a high risk of various complications. Hence, there is a general requirement
for risk assessments to consider all possible treatment planning.
