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Washington University Experience | NEOPLASMS (PINEAL) | PPTID (Pineal Parenchymal Tumor Intermediate Differentiation) | 4A3 PPTID(Case 4 ) H&E 5.jpg
Sections reveal a highly cellular neoplasm composed of sheets and large lobules of rounded to epithelioid cells with open chromatin, variable prominent nucleoli, and moderate quantities of clear to amphophilic cytoplasm. There are occasional mitotic figures. (H&E) ---- Not shown: There is strong and diffuse immunoreactivity for synaptophysin, neuron specific enolase, and neurofilament protein. Patchy tumoral immunoreactivity is seen with chromogranin. The Ki-67 labeling index is moderate. ---- Comment: The presence of a low mitotic index, absence of necrosis, and diffuse neurofilament protein immunoreactivity suggests a more favorable prognosis. However, the elevated Ki-67 proliferative index is somewhat worrisome for a more aggressive tumor and the tumor was diagnosed as PPTID WHO Grade 3.
