Neuro -- Pineal Region

Front 1

1. What is the DDX of pineal region mass?
2. What clinical syndrome is associated with pineal region mass?
3. What tumor is associated with trilateral retinoblastoma?

Back 1

1.
- Germ cell tumors account for the majority of pineal region masses.
- Pineal cell tumors account for 25% of pineal region masses.
- Less common masses in the pineal region = pineal cyst, meningioma, metastases, arachnoid cyst, epidermoid, dermoid. NOTE: Tectal plate glioma can mimic a pineal gland tumor.

**Germinomas, pineoblastoma, and pineocytomas can have CSF dissemination. Thus, image the entire neuroaxis to look for drop mets.
2.
- Parinaud’s syndrome: inability to gaze upward due to compression of the tectal plate.
- Hydrocephalus can occur due to compression of the cerebral aqueduct.
3. Pineoblastoma

NOTE: masses in the pineal region have mass effect upon the internal cerebral vein as masses can cause thrombosis of these vessels

Front 2

1. What are the common germ cell tumors to occur in the pineal region?
2. How does pattern of calcifications help distinguish the pineal region masses?
3. What are the imaging findings of germinoma?
4. How is germinoma treated?

Back 2

1.
- Most common germ cell tumor = germinoma.
- Less common = teratoma, embryonal cell carcinoma, choriocarcinoma, endodermal sinus (yolk sac) tumor.
2. Germinomas contain central calcifications. Pineoblastoma contain peripheral calcifications.
3.
- Highly cellular tumor -- therefore hyperdense on NECT and iso to hypointense on T2WI.
- Homogeneous enhancement
- Engulfs the pineal gland (which may be calcified); thus, a central calcification is seen with germinoma.
- High propensity for leptomeningeal dissemination. In particular, spread via the CSF often involves the suprasellar region.
4. Very sensitive to radiation therapy.

Front 3

1. What tumors arise from pineal cells?
2. What are the imaging features of pineoblastoma?
3. What are the imaging features of pineocytomas?

Back 3

1. Pineoblastoma (child) and Pineocytoma (adult)
2. PINEOBLASTOMA
- Peripheral calcifications
- Dense enhancement
- May invade adjacent parenchyma.
- Subarachnoid spread can be seen.
- Considered a type of PNET.
3. PINEOCYTOMA
- Smaller than pineoblastoma
- Better circumscribed than pineoblastoma
- More often calcified
- Often have cystic components.

Front 4

1. What are the 2 most common locations of a germinoma?
2. Germinomas are histologically similar to what testicular neoplasm?

Back 4

1.
- PINEAL REGION: mass in this region can result in hydrocephalus and/or Perinaud syndrome 2/2 compression of the tectal plate.

- SUPRASELLAR:
Diabetes insipidus due to involvement of pituitary infundibulum or visual disturbances from invasion of the optic chiasm
Precocious puberty if a ß-HCG secreting tumor
Hydrocephalus

2. Testicular seminoma.