Tumor staging for pineal region tumors of childhood

Abstract

The central midline location of the pineal gland, its intricate contact with cerebrospinal fluid pathways, and the generally large size of tumors in this area before they produce symptoms raise problems in the use of TNM classification. Biopsy was performed on 30 consecutive pineal region tumors seen in children detected over an 8-year period. The pathologic features did not conform to previous autopsy data. Germinomas comprised only 7% of tumors, whereas 23% were malignant germ cell tumors. Neither computerized tomography, magnetic resonance imaging scan, nor markers were shown to be diagnostic of pathologic type. It was concluded that the significant factors affecting outcome are tumor cell type and presence or absence or mitoses. Surgical biopsy is recommended for all pineal region tumors in children. At the current time, the data base is insufficient to devise a staging classification specific for pineal region tumors and the TNM system appears largely inappropriate. Thus, it is reasonable to develop a data base for tumors of this region that then may lead to a specific staging system.