Pineoblastoma en el adulto. A propósito de un caso

Orestes López-Piloto, Ernesto Enrique Horta-Tamayo, Luis César Acosta-González, Lismary Martinez Valdez

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Resumen

Fundamento: Los pineoblastomas son tumores cerebrales infrecuentes dentro del grupo de los tumores primitivos neuroectodérmicos. La presentación clínica por lo general está relacionada con la obstrucción del acueducto de Silvio, lo que ocasiona hidrocefalia e hipertensión intracraneal.

Objetivo: Describir las características clínicas e imagenológicas de un paciente adulto con diagnóstico de pineoblastoma.

Presentación de caso: Masculino, 33 años, que comenzó con disminución de la agudeza visual que evolucionó a la amaurosis bilateral y trastorno de la marcha. Se diagnosticó hidrocefalia obstructiva triventricular, por lo cual se realizó tercer ventriculostomía endoscópica. Se decidió un abordaje supracerebeloso infratentorial a la lesión tumoral, con apoyo endoscópico en posición semisentado; se logró la resección parcial. En estudio inmunohistoquímico se encontró Ki-67 mayor de 50 % de las células, neurofilamento y sinaptofisina positiva. Se concluyó como pineoblastoma. Recibió radioterapia convencional con Co-60, fraccionada, con un total de 30 dosis diarias de 2 Gy. La evolución del paciente a los 6 meses de operado fue satisfactoria.

Conclusiones: El tratamiento combinado de cirugía y radioterapia constituye un esquema terapéutico ideal en este tipo de lesiones tumorales. La endoscopia es una herramienta de gran valor en los abordajes quirúrgicos a la región pineal.

Palabras clave

Pineoblastoma; tumores neuroectodérmicos primitivos; región pineal; endoscopia.

Referencias

Cuccia V, Rodríguez F, Palma F, Zuccaro G. Pinealoblastomas in children. Childs Nerv Syst [Internet]. 2006 [cited 2022 Feb 20];22(6):577-85. Available from: https://link.springer.com/article/10.1007/s00381-006-0095-6

Luther N, Stetler WR, Dunkel IJ, Christos PJ, Wellons JC, Souweidane MM. Subarachnoid dissemination of intraventricular tumors following simultaneous endoscopic biopsy and third ventriculostomy: Clinical article. J Neurosurg Pediatr [Internet]. 2010 [cited 2022 Feb 20];5(1):61-7. Available from: https://thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/5/1/article-p61.xml

de Jong MC, Kors WA, de Graaf P, Castelijns JA, Kivelä T, Moll AC. Trilateral retinoblastoma: a systematic review and meta-analysis. Lancet Oncol [Internet]. 2014 [cited 2022 Feb 20];15(10):1157-67. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1470204514703365?via%3Dihub

Lee JYK, Wakabayashi T, Yoshida J. Management and Survival of Pineoblastoma: An Analysis of 34 Adults from the Brain Tumor Registry of Japan. Neurol Med Chir (Tokyo) [Internet]. 2005 [cited 2022 Feb 20];45(3):132-42. Available from: https://www.jstage.jst.go.jp/article/nmc/45/3/45_3_132/_pdf/-char/en

Cuccia F, Mortellaro G, Cespuglio D, Valenti V, Gregorio GD, Quartuccio E, et al. A Case Report of Adult Pineoblastoma Occurring in a Pregnant Woman. Anticancer Res [Internet]. 2019 [cited 2022 Feb 20];39(5):2627-31. Available from: https://ar.iiarjournals.org/content/anticanres/39/5/2627.full.pdf

Gener MA, Conger AR, Van Gompel J, Ariai MS, Jentoft M, Meyer FB, et al. Clinical, Pathological, and Surgical Outcomes for Adult Pineoblastomas. World Neurosurg [Internet]. 2015 [cited 2022 Feb 20];84(6):1816-24. Available from: https://www.sciencedirect.com/science/article/pii/S1878875015010165

Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol (Berl) [Internet]. 2016 [cited 2022 Feb 20];131(6):803-20. Available from: https://link.springer.com/article/10.1007/s00401-016-1545-1

McLendon RE, Yachnis AT, Miller CR, Ng H-K. Central Nervous System Tumor Classification: An Update on the Integration of Tumor Genetics. Hematol Clin [Internet]. 1 de febrero de 2022 [cited 2022 Dec 11];36(1):1-21. Available from: https://www.hemonc.theclinics.com/article/S0889-8588(21)00104-0/fulltext

Tate M, Sughrue ME, Rutkowski MJ, Kane AJ, Aranda D, McClinton L, et al. The long-term postsurgical prognosis of patients with pineoblastoma. Cancer [Internet]. 2012 [cited 2022 Feb 22];118(1):173-9. Available from: https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.26300

Motiei-Langroudi R, Sadeghian H, Soleimani MM, Seddighi AS, Shahzadi S. Treatment Results for Pineal Region Tumors: Role of Stereotactic Biopsy Plus Adjuvant Therapy vs. Open Resection. Turk Neurosurg [Internet]. 2016 [cited 2022 Feb 22];26(3):336-40. Available from: http://www.turkishneurosurgery.org.tr/pdf/pdf_JTN_1685.pdf

Choudhri AF, Whitehead MT, Siddiqui A, Klimo P, Boop FA. Diffusion characteristics of pediatric pineal tumors. Neuroradiol J [Internet]. 2015 [cited 2022 Feb 20];28(2):209-16. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4757159/

Hinkes BG, von Hoff K, Deinlein F, Warmuth-Metz M, Soerensen N, Timmermann B, et al. Childhood pineoblastoma: experiences from the prospective multicenter trials HIT-SKK87, HIT-SKK92 and HIT91. J Neurooncol [Internet]. 2007 [cited 2022 Feb 20];81(2):217-23. Available from: https://link.springer.com/article/10.1007/s11060-006-9221-2

Horta-Tamayo EE, Acosta-González LC, Ortega-Raez DR, Rodríguez-Santillán LB. Tercer ventriculostomía endoscópica en hidrocefalia secundaria a tumores de fosa posterior en adultos. Rev Cienc Médicas Pinar Río [Internet]. 2021 [citado 20 Feb 2022];25(6). Disponible en: http://scielo.sld.cu/pdf/rpr/v25n6/1561-3194-rpr-25-06-e5273.pdf

Lutterbach J, Fauchon F, Schild SE, Chang SM, Pagenstecher A, Volk B, et al. Malignant Pineal Parenchymal Tumors in Adult Patients: Patterns of Care and Prognostic Factors. Neurosurgery [Internet]. 2002 [cited 2022 Feb 20];51(1):44-56. Available from: https://mayoclinic.pure.elsevier.com/en/publications/malignant-pineal-parenchymal-tumors-in-adult-patients-patterns-of

Mynarek M, Pizer B, Dufour C, van Vuurden D, Garami M, Massimino M, et al. Evaluation of age-dependent treatment strategies for children and young adults with pineoblastoma: analysis of pooled European Society for Paediatric Oncology (SIOP-E) and US Head Start data. Neuro Oncol [Internet]. 2017 [cited 2022 Feb 20];19(4):576-85. Available from: https://doi.org/10.1093/neuonc/now234

Huanca Amaru J, López Piloto O, Abreu Casas D, Rodríguez de la Paz NJ, Llerene Bernal M. Tumor pineal resuelto por Abordaje Infratentorial supracerebeloso Endoscópico. Reporte de un caso y revisión de la literatura. Rev Argent Neurocir [Internet]. 2020 [citado 20 Feb 2022];358-64. Disponible en: https://www.ranc.com.ar/index.php/revista/article/view/59/153

Glanzmann C, Seelentag W. Radiotherapy for tumours of the pineal region and suprasellar germinomas. Radiother Oncol [Internet]. 1989 [cited 2022 Feb 20];16(1):31-40. Available from: https://pubmed.ncbi.nlm.nih.gov/2813835/

Kumar N, Srinivasa GY, Madan R, Salunke P. Role of radiotherapy in residual pineal parenchymal tumors. Clin Neurol Neurosurg [Internet]. 2018 [cited 2022 Feb 20];166:91-98. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0303846718300337?via%3Dihub

Gaito S, Malagoli M, Depenni R, Pavesi G, Bruni A. Pineoblastoma in Adults: A Rare Case Successfully Treated with Multimodal Approach Including Craniospinal Irradiation Using Helical Tomotherapy. Cureus [Internet]. 2019 [cited 2022 Feb 20];11(10). Available from: https://www.cureus.com/articles/20962-pineoblastoma-in-adults-a-rare-case-successfully-treated-with-multimodal-approach-including-craniospinal-irradiation-using-helical-tomotherapy

Biswas A, Mallick S, Purkait S, Gandhi A, Sarkar C, Singh M, et al. Treatment outcome and patterns of failure in patients of pinealoblastoma: review of literature and clinical experience from a regional cancer centre in north India. Childs Nerv Syst [Internet]. 2015 [cited 2022 Feb 20];31(8):1291-304. Available from: https://link.springer.com/content/pdf/10.1007/s00381-015-2751-1.pdf

Packer RJ, Gajjar A, Vezina G, Rorke-Adams L, Burger PC, Robertson P, et al. Phase III study of craniospinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma. J Clin Oncol [Internet]. 2006 [cited 2022 Feb 20];24(25):4202-8. Available from: https://facultyopinions.com/prime/718450219

Gerber NU, von Hoff K, Resch A, Ottensmeier H, Kwiecien R, Faldum A, et al. Treatment of children with central nervous system primitive neuroectodermal tumors/pinealoblastomas in the prospective multicentric trial hit 2000 using hyperfractionated radiation therapy followed by maintenance chemotherapy. Int J Radiat Oncol [Internet]. 2014 [cited 2022];89(4):863-71. Available from: https://www.sciencedirect.com/science/article/pii/S0360301614004878



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