Glioblastoma de la región pineal: reporte de un caso y revisión de la literatura

Abstract

Tumors of the pineal region represent 0.1-0.4% of primary brain tumors 1) The most frequent are germ cell, followed by originated from pineal parenchyma cells. Less frequently, there are glial and miscellaneous; 2) Among gliomas, the most frequent one is the well-differentiated astrocytoma; 3) The glioblastoma is an infrequent finding. We report a case of 62-year- old patient, with symptoms of altitude diplopia and headache. Imaging studies upon admission revealed supratentorial hydrocephalus; pineal lesion with an infiltrative appearance; and suggestive aspects of leptomeningeal spread. Metastatic lesions were found in the spinal region. The biomarkers were negative. Initial treatment consists of performing fenestration of the lamina terminalis as the management of hydrocephalus. A biopsy of an extramedullary spinal lesion T10-T11 was performed, which was reported as a high-grade IDH 1 non-mutated glioma, with vascular microproliferation and numerous mitotic figures. Natural history allows a survival rate of only 5 months. Pineal glial tumors are rare. Cases with characteristics of Malignant Gliomas may correspond to WHO grade 3 Astrocytomas and less frequently to Glioblastomas. Its diagnosis requires detailed histological and immunohistological studies, the presence of leptomeningeal dissemination is more frequent in Glioblastomas. Despite all the therapeutic options available, these types of tumors have a low survival rate.