Pineal glioblastoma: a case series and updated literature review

Pineal region glioblastoma (GBM) is an exceptionally rare entity. Clinical and biological distinctions from conventional GBM remain unclear, particularly in light of the updated 2021 WHO classification.

We reviewed our institutional neuro-oncology database (2000-2025) to identify adult pineal tumours meeting the 2021 WHO CNS criteria for GBM. Demographic, radiological, treatment, and survival data were analysed. A systematic literature review of pineal GBM was also conducted.

We report 53 cases of pineal GBM (3 institutional cases) with a median age=52 years, age-rage=18-74, male:female=1:1.4. Hydrocephalus and leptomeningeal dissemination were present at diagnosis in 73.6% and 34.6%. Surgical resection was performed in 34 patients, with near total resection or greater achieved in 7. Median overall survival (OS) was 8.5 months (range 0.2-42 months), and two-year survival was 13.2%. Surgical resection (7.25 vs 11 months; p=0.5923, log-rank Mantel-Cox) and leptomeningeal spread (8.5 vs 9 months, p=0.6726, log-rank Mantel-Cox) did not significantly affect median OS. Notably, one of our patients demonstrated long-term survival despite unfavourable molecular features.

This represents the first pineal GBM cohort defined under 2021 WHO classification. Our findings highlight the heterogeneity of outcomes, underscoring the need for molecular and epigenetic stratification to refine prognostication and therapeutic decision-making.