The Comparasion Of Clinical,imaging And Pathologic Features In Pineal Region Tumor

Part I Retrospective analysis of clinical and epidemiology of pineal region tumor ObjectiveA retrospective analysis was made on the clinical date of 113 pineal region tumors from 2010 to 2017,analysis the clinical features of pineal region tumors and the age distribution characteristics and gender differences of different pathological types.Materials and methods1.Research object and methods113 cases of pineal region tumors confirmed by operation and pathology were selected from 2010 to 2017 by the PACS system of the our hospital,retrospective analysis of their clinical features.According to histoenesis features tumor classification can be divided into germ cell tumors,pineal parenchymal cell tumors,neuroglial tumors and meningeal tumor.2.Pathological examination methodsAll patients underwent surgical resection.The specimens were fixed with 4%formaldehyde,decalcified with 8%hydrochloric formate,and embedded in paraffin for routine HE staining.All specimens observed the histological findings in light microscopy,most cases underwent immunohistochemistry.3.Statistical analysisAll data were analyzed by using IBM Statistical Package for the Social Sciences 23.0 software for statistical analysis,P<0.05 which was considered statistically significant.Sex,age distribution and the incidence of benign,borderline and malignant tumors in different pathological types of pineal region were compared using ?2 test.ResultsThere were statistically significant differences in sexes between different pathological types of the pineal region tumors(P<0.001);there were significant differences in onset age between different pathological types of the pineal region tumors(P<0.001);there were significant differences in the incidence of benign,borderline and malignant tumors between different pathological types of the pineal region tumors(P<0.001).Conclusion1.Germ cell tumors were the most common in pineal region,pineal parenchyma cell tumors and glial tumors were next,meningeal tumors were relatively rare.Malignant tumors were more common in pineal region.2.The age of onset of germ cell tumor was small,which more common in male.The age range of pineal parenchymal cells and glial tumor was big.The overall incidence of meningeal neoplasms was older.3.The clinical manifestations of pineal region tumors were not specific.Laboratory tests have a high specificity for the diagnosis of germ cell tumors.Part II Imaging and pathological analysis of pineal region tumor ObjectiveA retrospective analysis of 113 patients with pathologically confirmed pineal region tumor.Further understand the imaging features of various types of tumors and different pathological types,and improving the imaging diagnosis and differential diagnosis of pineal region tumors.Materials and methods1.Research object and methods113 cases of regional tumor of pineal body confirmed by surgery and pathology were collected from 2010 to 2017,and the imaging data of the patients were analyzed retrospectively.CT plain scan was performed in 74 patients.All patients underwent MRI scan and enhanced scan,of which 76 patients were performed DWI scan and 21 patients performed MRS scan.The pathological classification and analysis of pineal region tumors were the same as the first part.All the images were reviewed by a junior doctor and a senior doctor.The imaging analysis of lesions mainly includes the following aspects:size,shape,border,density,cystic degeneration,necrosis,hemorrhage,calcification,calcification location,MRI signal characteristics,MRS manifestation,enhancement degree.and enhancement mode.2.Pathological examination methods The same to part I.3.Statistics analysisThe data were analyzed by using SPSS23.0 statistical software package,and P<0.05 which was considered statistically significant.The imaging features of the pineal region tumor of different pathological types,and benign,borderline and malignant were compared by chi-square test.ResultsThere was significant difference in the incidence of calcification between different pathological types of the pineal region tumors(P = 0.001).The difference of calcifications was statistically significant between germ cell tumors and pineal parenchymal cell tumors(P = 0.02).The tumor morphology in the benign,borderline and malignant pineal region tumor was statistically significant(P = 0.003);tumor size in benign,borderline and malignant pineal region tumor was no significant difference(P = 0.887).There was significant difference in the incidence of cystic degeneration in different pathological types of pineal region tumor(P<0.001).The difference of cystic degeneration rate in benign,borderline and malignant pineal region tumors was statistically significant(P=0.004).The morphology of cystic degeneration in non-germionmatous germ cell tumor and other pathological types of pineal region tumors was significantly different(P=0.002).The enhancement level and enhancement method of different pathological types of pineal region tumor was statistically significant(P = 0.001,P<0.001).There was significant difference in the enhancement level and enhancement method between benign,borderline and malignant pineal region tumors.(P = 0.003,P = 0.008).Conclusions1.Calcification in the pineal region tumor common in germ cell tumor and pineal parenchymal tumor.Mostly in germ cell tumor calcification at the center of the tumor,pineal parenchymal tumor located in the edge of the tumor and more often rupture,2.The size of the tumor in benign and malignant tumor was not obvious difference.Most of pineal region tumors had clear border,benign,borderline and low-grade malignant tumors(such as germinoma)showed more morphological rules,the higher the degree of malignancy were mostly irregular or lobulated lobular changes.3."Butterfly sign" for the diagnosis of germinoma with specificity,pineal parenchyma cell tumors could grow along the ventricular system when casting.Part of the meningioma visible "meningeal sign."4.The incidence of cystic degeneration necrosis were the most common in germ cell tumors,and multiple small cystic.changes of non-germionmatous germ cell tumor with high specificity.Besides,the cystic degeneration necrosis rate of malignant was significantly higher than benign and borderline tumors.5.Intra-tumor hemorrhage more common in choriocarcinoma and choriocarcinoma containing components of mixed germ cell tumors,some high level glioma and pineal parenchymal tumo may also be associated with intratumoral hemorrhage.6.If the pineal region tumors lack characteristic imaging findings,diagnosis should be combined with the pineal area tumor epidemiology and clinical characteristics to be identified.