Study shows a hyperdense enhancing mass lesion in the region of the pineal
gland with mass lesions in the left temporal lobe, and enhancement of the
Pineal Gland Tumor with mets (CSF spread)
Pineal region tumors are rare, comprising about 1% of adult and 3% to 8%
of pediatric brain tumors. Pineal region tumors include tumors that arise
in the pineal gland as well as a small proportion of those that arise in
the suprasellar region. However, most suprasellar tumors, such as
craniopharyngiomas and pituitary adenomas, are obviously not of pineal
Tumors of the pineal region can produce a variety of symptoms, including
symptoms of increased intracranial pressure (eg, headache, nausea,
vomiting, and seizures related to ventricular outflow obstruction),
disturbances of gaze due to compression of the mesencephalon, and various
endocrine or motor/sensory disorders related to compression of the
hypothalamus or cerebellum, respectively.
Pineal Gland Tumors
The three major categories are tumors of germ cells, pineal parenchymal
cells, and supporting tissues.
Pineal region germ cell tumors arise from embryologic germ cell
rests that reach the gland after aberrant migration during early
development. As a group, germ cell tumors are the most common pineal
tumors. Pineal germ cell tumors tend to occur in adolescence and young
adulthood and are rare in females.
The most common pineal tumor is
the germinoma, accounting for more than 50% of all tumors occurring in the
gland. It is a malignant tumor that typically affects young males in their
teens or twenties. Germinomas may be well circumscribed or infiltrative,
and they have a high propensity for seeding the spinal cord, and
typically, germinomas engulf a calcified pineal gland. Pineal teratomas,
and other germ cell tumors such as yolk sac tumor, choriocarcinoma and
embryonal carcinoma can also occur, but are rare, and prognosis is poor.
Pineal parenchymal tumors can be divided into undifferentiated
pinealoblastomas, well-differentiated pinealomas, and intermediate and
mixed types. The pinealoblastoma is a highly malignant tumor that affects
children and young adults and occurs more frequently in males. The tumors
tend to be ill defined and infiltrative, with a propensity to metastasize
to the spinal cord.
Pinealomas are benign tumors that
tend to affect people in mid to late adulthood, with no sex predilection.
Prognosis after excision is excellent.
account for up to 33% of pineal tumors and range from low-grade
astrocytomas, which are most common, to the highly malignant glioblastoma
multiforme. Pineal ependymomas, oligodendrogliomas, and choroid plexus
papillomas are rare.
Germ cell tumors tend to be very homogenous masses on CT and MR and are
always slightly denser than normal brain on NCCT. On MR they are
isointense to gray matter on T1, and iso/ sightly hyper intense on T2WI.
Both CEMR and CECT display homogenous enhancement of the tumor. Intrinsic
pineal tumors are usually similar in appearance: partially calcified, and
hyperdense on NCCT, with dense enhancement. Pineal gland may also harbor
another PNET, and this condition with bilateral ocular lesions is called
Ashok Raghavan, Manipal Hospital, Bangalore