Papillary Tumor of the Pineal Region Treated With Surgery and Postoperative Radiotherapy: A Case Report

Papillary tumors of the pineal region (PTPR) are extremely rare malignancies that make up less than 0.1% of primary brain tumors. They are usually treated with surgery and adjuvant tumor bed radiotherapy (RT). We review the case of a man in his late 60s who presented with two weeks of confusion and ataxia. Imaging the head with computed tomography (CT) and magnetic resonance imaging (MRI) showed hydrocephalus and a 2 cm pineal region mass. We review the presenting symptoms, investigations, and differential diagnosis for patients with pineal region masses. The pathological features, initial hydrocephalus management, and curative treatment of his tumor with surgery and RT are discussed. We also review the PTPR literature, including prognostic features and the evidence for treatment modalities, and report adjuvant radiotherapy treatment planning volumes. The patient is symptom-free and without evidence of recurrent disease on follow-up MRI 18 months after treatment. PTPR has very high recurrence rates following treatment; less than 20% of patients have local control at 10 years, and further research is needed to find more effective interventions and improve patient outcomes.