Diagnosis and management of pineal tumors

Abstract

The management of pineal region tumors remains controversial. Advocates of a conservative approach emphasize the excellent results of radiotherapy, particularly with germinomas, while a number of recent reports have demonstrated the safety of direct surgery. In order to improve treatment planning, attempts have been made to distinguish the various tumor types by computerized tomography (CT) and by the use of markers for germ-cell tumors. This paper reports a study of 35 patients with pineal tumors including two ectopic germinomas. Pretreatment CT was performed in all 35 patients, and human chorionic gonadotropin and alpha-fetoprotein levels were assayed in 11. Histological verification was available for 33 tumors; the other two were characterized by clinical and CT features plus tumor markers. Of the 27 tumor operations, 21 were for a pineal mass and six for ectopic germinoma or metastasis. There was no operative mortality. Morbidity was minimal, and surgery did not increase the incidence of subarachnoid seeding. Each histological type of tumor has a typical appearance on CT scanning, although, in the individual case, a firm diagnosis is not always possible. However, consideration of CT scans together with the clinical features, cerebrospinal fluid cytology, tumor markers, and (if there is still doubt) response to a small dose of irradiation will generally allow a specific diagnosis with a high degree of probability. In this way, germinomas may be selected for radiotherapy and the tumors less likely to respond may be subjected to primary surgery.

Isolated Adrenocorticotrophin Deficiency Associated with Anti-Pituitary Antibodies, Pituitary Cyst, Sphenoidal Cyst and Pineal Tumor.

“…No aqueductal obstruction, Parinaud's syndrome or any other endocrinological manifestations was found. Pineal tumors may be classified into two groups: tumors of germ cell origin and tumors of pineal cell origin [19]. The former are of two major subtypes: germinomas and teratomas.…”

Our Experience with Infratentorial Supracerebellar (ITSC) Approach for Pineal Region Tumor Excision

“…So, complete tumor removal has been clearly established an optional treatment for pineal tumors. 2,7,11,14,16,20 Surgical resection can provide; 1) tissue diagnosis with a greater diagnostic yield than stereotactic biopsy, 2) total cure with benign lesions, 3) cytoreduction to improve the effi cacy of chemotherapy and radiotherapy and 4) restoration of the CSF fl ow through the removal of the tumors block.…”

“…Commonly used approaches for pineal region tumors are infratentorial supracerebellar (ITSC), occipital transtentorial, transcallosal interhemispheric and transcortical transventricular 2,3,4,8,11,13,16,20,22,23,31,32 The fi rst successful removal of a pineal tumor was reported by Krause and Oppenheim in 1913 and they had removed the tumor using ITSC approach. 21 Then in 1926, Krause described modest success without operative mortality in three patients.…”

“…Treatment modalities include tumor biopsy to total excision of tumor . 1,2,4,9,11,14,26,28,31 There are several surgical approaches for open surgery to pineal regions tumor, however, infratentorial supracerebellar (ITSC) approach has been widely accepted and used worldwide and about 90% of pineal region tumors can be removed using this approach. 3,16,20,22,23,32 Oppenheim and Krause reported the fi rst successful pineal region tumor removal in 1913 using ITSC approach.…”

CT of pineal tumors and intracranial germ-cell tumors

“…Embryonal carcinoma has the potential to differentiate into mature or immature teratoma, teratocarcinoma, choriocarcinoma, on yolk-sac tumor [3]. Some cases of tenatocarcinoma and tematoma may have elevation of AFP or HCG [2,6,7]. Therefore, neoplasms of germ-cell origin can be classified not only according to their morphology but also by the specific biologic marker (HCG or AFP) they produce.…”