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A Journal on Neurosurgery

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Journal of Neurosurgical Sciences 2016 Jan 08


language: English

Increased VEGF levels in one case of papillary tumor of the pineal region with intracranial haemorrhage at presentation: a potential surrogate indicator of tumor angiogenesis and aggressiveness?

Giovanni MARFIA 1, Antonella AMPOLLINI 2, Stefania Elena NAVONE 1, Clara DI VITO 3, Andrea BORNATI 4, Monica MIOZZO 5, Gisele DE REZENDE 4, Paolo RAMPINI 1, Laura RIBONI 3, Maria Elisa MANCUSO 6, Rolando CAMPANELLA 1

1 Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Italy; 2 Neurosurgery Unit, Ospedale San Carlo Borromeo, Milan, Italy; 3 Department of Medical Biotechnology and Translational Medicine, University of Milan, LITA Segrate, Milan, Italy; 4 Department of Pathology, Ospedale San Carlo Borromeo, Milan, Italy; 5 Division of Pathology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Italy; 6 Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy


Pineal tumors are rare, about 1% of all intracranial tumors. At variance with pineocytomas, usually characterized by a good prognosis, papillary tumors behave more aggressively. Owing to their rarity, little is known about their biology and clinical behavior, moreover conflicting data on prognosis have been reported. Here we present an unusual case of papillary neuroepithelial tumor of the pineal region in a 40-years old man who was admitted in a state of unconsciousness due to the presence of intracranial haemorrhage. After 21 days from admission, he underwent third ventriculostomy for hydrocephalus and biopsy of the lesion. Since bleeding manifestations are uncommonly associated with this kind of tumors, we performed some additional non routine laboratory tests in order to identify biological indicators of disease course and abnormal angiogenesis. Coagulation screening tests were performed to rule out the presence of coagulopathy and vascular endothelial growth factor (VEGF) levels measured in plasma as marker of tumor angiogenic potential. Histologic evaluation confirmed the diagnosis of a papillary tumor of the pineal region with the presence of tiny vessel lumens that may account for increased angiogenesis Coagulation screening was normal and VEGF levels were extremely high if compared to healthy individuals. After 20 months of follow-up the tumor mass, radiotherapy treated, appeared dramatically reduced at MRI evaluation, and, interestingly, VEGF levels, although still higher than in healthy individuals, resulted significantly decreased as compared to those measured at time of first hospital admission suggesting a role for VEGF as indicator of tumor aggressiveness. In conclusion, measurement of angiogenesis circulating soluble markers could have an additional feedback in the diagnosis, therapy and monitoring the disease in patients with very rare CNS tumors as papillary tumors of pineal region that have non univocal clinical behavior and prognosis.

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