Hoshino, Noburu

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Title Ectopic Pinealoma : Report of Three Cases.Author(s)Hoshino, NoburuCitation日本外科宝函 (1953), 22(2): 145-147Issue Date1953-03-01URL http://hdl.handle.net/2433/205977RightType Departmental Bulletin PaperTextversionpublisherKyoto University145 症????，? ?? 報? ?Ectopic Pinealoma. Heport of Three℃asc札〔Fromthe 1st Surg,ical Division, Kyoto University T¥f吋icalSchool〕(Di;・ector: Prof. CrusA1・0 ARAKI) by Noburu Hoshino (ReceiHd for publication, Jan. 9, 1953) Case Report Case I, A. T., a仰wnaged 28. Subcortical cyst with a例uralnodule of ty pie al pi仰ea-loma in the left frontal lobe. Tumor of the pineal body was excluded by the iodized cil ventriculography. The patient was admitted to our hospital complainin5 of headache, right hemiplegia and of difficulty in speech. Tumor in the left cerebral hemisphere, maybe in the frontal lobe, was suspected from neurologic findings and was Ye了ifiedby the iodized oil ventricu-lography. Left frontal craniotomy was perfoτmed. By exploratory puncture through the dural membrane, clear fluid of straw-yellow color was obtained at a depth of 1 cm. The cortex was incised and the cyst e¥・acuated. It was unilocular with a mural nodule of 3 cm. in diam~ter at the bottom. The nodule was removed totally. Microscopic features of the mural nodule: Tumor tissue contains well developed stroma of connective tissue and ra-ther few blood vessels. Tumor cells are characteristic of pinealoma, consisting of admixture of t¥・o types of cels, the one being large epitheloid cels and the other lymphoid cellsιFig. 1 . Case 2, K. N., a boy aged 18. Pinealoma or pineoblas-toma in the region of the right basal ganglia. Nn clinical symptoms suggesting a tumor in the pineal region. He was admitted to the hospital complaining of right Fig. 1 hemiplegia of fo:ir months duration. It was at first considered, on the basis of clinical findings, there may be a tumor in the right side of the midbrain, but, the correct diagnosis of a tumor in the region of the right basal ganglia was made by the air study. Right fronto-parieto四temporalflap was turned down. By e文ploratorypuncture, a mass of tumor-like hardness was touched at a depth of 3.5 cm. from the surface. Dissecting the cortex the tumor tissue was curetted subtotally piece by piece. The size of the tumor appeared to be as large as a sparrow’s egg. Microscopic features of the tumor tisue: The tu-mor is considerably cellular and large cels with round vesicular nuclei are packed together without showing any arrangement or pattern. Some nuclei of these cells contain nucleoli. A few lymphoid cells are scattered between larger cells. The tumor may be a pinealoma or a pineoblastoma ・Fig. 2 '.Case 3, T. N, a woman aged 26 Pineublastoma in the left lateral ventricle. Autopsy. Pineal body of仰or-Fig. 2 押wlsize印刷rmalposition. She had been su宜eringfrom failure of vision and headache since one and a half years before admission. A cerebral tumor was suspected, but the precise localization was obscure. 146 日木外科~曲第22を tr·;2貌Definite diagnosis of tトEleft lateral ventricle tumor ¥YaS obtained by the iodized oil wntriculography. Left fronto-temporal craniotomy was done. The opera-tion, however, had to be gi¥・en up without finding out a tumor because of th巴criticalcondition of the patient. She died forty three hours after operation. Autopsy ・ An oval tumor of 6×4×2.5 cm. was found in the middle portion of the left lateral ventricle, attaching to its lateral wall. It was grayish red in color and elastic soft in consistency, being covered with thin capsule. The pineal body existed in normal position with normal shape (Fig. 3). Microscopic findings: The tumor tissue is moderately cellular but not so vascular. Tumor cells ar巴 roundor oval in shape and almost uniform in size, having scanty protopl・asm. Nuclei are vesicular and contain a few chτomatin granules. Neuroblasts, spongioblasts and connectiYe tissue can not be found. It can be diagnosed as pineoblastoma (Fig. 4). Discussion AboYe mentioned three cases are al ectopic pinealomas, i. e., case 1 in th巴leftfrontal lobe, case 2 in the region of the right basal ganglia and cases 3 in the left lateral vent-ride. The prese口ceof a primary ;)ineal tumor can b巴 deniedby iodized oil ventriculography in case 1., from neurologic 五ndingsin case 2. and by autopsy in case 3. I. R Fig. 3 Fig. 4 There may b巴threepossibilities for the occurrence of pinealoma in the unusual, ectopic region. In the first place a tumor of the pineal body may extend so far to the remote region. NISHINO') has reported in detail a case of pinealoma invading extensiwly the midbrain and the diencephalon. The second is the metastasis of a primary pineal tumor. In spit巴 ofits essentially benign natur.e, the disseminated metastases of pinealoma in the subarachnoid space or in the ventricle wall by the flow of the cerebrospinal fluid, as in the case of medulloblastoma, are well known. There are considerable number of reports of such cases by BERBLINGER2> and others. The third possibility is the primary ectopic occurrence of pinealoma without a tumor of the pineal body itself. AKASAKI，り $TARK1>and others have reported such cases. Common location of those ectopic pinealomas isthe infundibular region. Peculiar cases have been described by MACKAY') and FORD and MuNcm,r.J in which the whole ventricular wall is replaced by the layer of pinealoma tissue without forming any circumscribed tumor mass. MACKAY states that the pineal body is nothing but a highly di妊erentiatedventricular ependymal tissue and suggests the possibility for arising of pinea-loma from any part of the ventricular ependyma. It seems to me that my case 3. offers an evidence for his assumption, because there can te litle doubt in the case about the ependymal origin of the tumor, ha、ingno contact with the pineal body. Histogenesis of the ectopic tumor can most easily be attributed to the aberrant embr-yonic cel rests. Admitting, however, the ependymal origin of pinealoma, as MACKAY suggests, ther巴remainsthe possibility that in cases 1 and 2, tumors may have arisen from Yentricular ependyma and ha ¥'e deYeloped巴xtraventricularly towards the subcortex of the Ectopic Pii:Jealoma 147 cerebrum. As I7> have previously described, such mode of growth is not infrequently ex-perienced with ependymomas. Isn’t there an analogy between ependymoma and pinealoma of ependymal origin? If this supposition may be taken for granted, ectopic histogenesis in my three cases can be coherently explained, i. e. a pinealoma originating from ventric-ular ependyma has developed extraventricularly in cases I and 2, and intraventricularly in case 3. Summary I. Three cases of. ectopic pinealoma have been reported, case I in the left frontal lobe, case 2 in the region of the right basal ganglia and case 3 in the left lateral ventricle. 2. Ependymal origin of the pinealoma seems to be probable. References 1. NrsHINO, 1940, Hokuetsu-Igaku, 55, 879. 2. BERBLINGER, 1925, Ztschr. f. d. ges. Neur. Psych. 95, 741. 3. AKASAKI, 1939, Tokyo-Iji-Shinshi, No. 3121, 391. 4. STARK, 1928, Zbl. f. d. ges. Neur. Psych. 48, 72. 5. MACKAY, 1939, Arch. Neurol. Psychiat., 42, 903. 6. FORD and MUNCIE, 1938, Arch. Neurol. Psychiat., 39, 82. 7. HosHINO, 1950, Folia Psychiat. Neurol. Japon., 4, 205. 異所性ビネアローマの3例（抄録）松果休自身に腫湯形成を認めない原発性異所性ピネ するのが最も容易ではあるが， 第3例の所見は寧ろ悩アローマの3例を報告した．第1例は28才の男．左前 室上衣より発生したもの主する方が妥当である．然り頭葉皮質下にあって控在性結節を有する褒蟻で組織掌 とすれば，第I，第2{!ITでは剖検を欠いて居るので断的に定型的ピネアローマ．第2例は18才の男．右終~菌 言It.出来ないが，此等もH菌室蓬から発生したピネアロ核部の雀卵大の1壇場．組織像はピネアローマ～ピネオ ーマが必室外に肉って発育したものではないだろ うプラスト戸マ．第3例は26才の女．左側A菌室中央部に か．エベンデ4モF マの湯合，我 は々再三，脳室墜か発生した6x4×2.Scmの脳室内腿湯で組織学的所見は ら発生した臨海が泌室内院へ肉ってではなく，皮質下ピネオプラストーマ． の方向に向って発育し？と例を経験して居る．異所性ピネアローマは組織迷芽から発生すると説明

異所性ピネアローマの３例

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異所性ピネアローマの３例

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