Pineal tumors
Papillary
tumour of the pineal region: a case report. a Sagittal T1-FLAIR. b Axial T1-weighted magnetic resonance imaging (MRI)
Pineal region
mass • Pineal region epidermoid cyst - Ganzer Fall bei Radiopaedia
Pineal region
mass • Pineal region meningioma - Ganzer Fall bei Radiopaedia
Pineal region
mass • Pineal germinoma - Ganzer Fall bei Radiopaedia
Pineal region
mass • Pineal germinoma - Ganzer Fall bei Radiopaedia
Pineal region
mass • Pineal region cavernoma - Ganzer Fall bei Radiopaedia
Brain tumors
• Non-germinomatous germ cell tumor (pineal) - Ganzer Fall bei Radiopaedia
Pineal region
mass • Pineocytoma - Ganzer Fall bei Radiopaedia
Magnetic
resonance imaging of pineal region tumours. Atypical teratoid/rhabdoid tumour (AT/RT) in a 10-month-old boy. Sagittal T1-weighted image (a) shows a large tumour with poorly-defined margins involving the pineal gland and midbrain (arrow), which is heterogeneous and predominately isointense to grey matter. The tumour (arrow) has intermediate to high signal on an axial T2-weighted image (b), and shows prominent contrast enhancement with irregular margins on axial T1-weighted image (c)
Metastase
eines Plattenepithelkarzinoms der Lunge in der Glanula pinealis. Es waren mehrere weitere Metasatasen in anderen Hirnregionen nachweisbar.
Metastase
eines Plattenepithelkarzinoms der Lunge in der Glanula pinealis. Es waren mehrere weitere Metasatasen in anderen Hirnregionen nachweisbar.
Trilateral
retinoblastoma: A rare tumor involving the “third eye”. Sagittal T1 FLAIR demonstrates the heterogeneous midline pineal (arrow).
Trilateral
retinoblastoma: A rare tumor involving the “third eye”. Axial T1 post Gadolinium shows a lobulated and heterogeneously enhancing mass in the region of the pineal gland.
MRI of
papillary tumor of the pineal region (PTPR) in an 18-year old boy. Sagittal T1+Gd. Image modified to obscure patient identity.
Magnetic
resonance imaging of pineal region tumours. Pineocytoma in a 35-year-old woman. A well-circumscribed low-attenuated lesion arising from the pineal gland producing the characteristic “explosion” of normal pineal calcifications (arrow) towards the periphery
Magnetic
resonance imaging of pineal region tumours. Pineoblastoma in a 18-month-old boy. A well-circumscribed tumour arising from the pineal gland (arrow), which is isointense to grey matter on sagittal T1-weighted image (a), intermediate to high signal on axial T2-weighted image (b) and shows contrast enhancement on sagittal T1-weighted image (c). The tumour shows restricted diffusion as seen on diffusion-weighted image (d). The tumour causes obstructive hydrocephalus by exerting localised mass effect and compression of the quadrigeminal plate and cerebral aqueduct. Hydrogen MR spectroscopy at 1.5 T using a single voxel (2 × 2 × 2 cm3) acquisition with point resolved spectroscopy (PRESS) demonstrates elevated choline peak (*) and decreased NAA (**) (e). Corresponding T1-weighted image shows location of the voxel surrounding the tumour (f)
Magnetic
resonance imaging of pineal region tumours. Pineocytoma in a 65-year-old woman with worsening headaches. A circumscribed slightly-lobulated lesion (arrow) with low to intermediate signal on axial T2-weighted image (a) involves the pineal gland. The lesion shows prominent diffuse contrast enhancement on axial (b) and sagittal (c) T1-weighted images (arrow)
Magnetic
resonance imaging of pineal region tumours. Pineal parenchymal tumour of indeterminate differentiation (PPTID) in a 33-year-old woman with blurry vision and headaches. A circumscribed lesion with well- defined margins is seen involving the pineal gland (arrow), which has mixed intermediate and high signal on axial (a) and sagittal (b) T2-weighted images. The tumour shows heterogeneous contrast enhancement on sagittal T1-weighted image (c)
Zufallsbefund
einer relativ großen Pinealiszyste bei einer jungen Frau. Magnetresonanztomographie T2 sagittal.
Magnetic
resonance imaging of pineal region tumours. Papillary tumour of the pineal region (PTPR) in a 6-year-old girl. A circumscribed lesion with well-defined margins is seen involving the pineal gland (arrow) with mass effect on the third ventricle and quadrigeminal plate. The tumour has intermediate to high signal on sagittal T1-weighted image (a) and axial T2-weighted image (b). The tumour shows heterogeneous contrast enhancement on axial T1-weighted image (c)
Magnetic
resonance imaging of pineal region tumours. Germinoma in a 12-month-old girl. Poorly-lobulated mass arising from the pineal gland (arrow), which has intermediate to high signal on sagittal T1-weighted image (a) and axial T2-weighted image (b), and shows contrast enhancement on sagittal T1-weighted image (c). Disseminated tumour (arrowhead) is also seen in the lateral and third ventricles with prominent enhancement. The tumour shows no restricted diffusion (d). MR spectroscopy at 1.5 T using a single voxel (2 × 2 × 2 cm3) acquisition with PRESS demonstrates elevated choline peak (*) and slightly decreased NAA peak (**) (e). Corresponding T1-weighted image post contrast shows the location of the voxel around the lesion (f)
Magnetic
resonance imaging of pineal region tumours. Teratoma in a 56-year-old man with worsening confusion and ataxia. The pineal lesion (arrow) is hyperintense relative to brain with foci of very low signal on sagittal T1-weighted image (a) and mixed low, intermediate and high signal on axial T2-weighted image (b). Internal foci and peripheral rim of low signal on T1-weighted and T2-weighted images correspond to calcifications seen on axial CT image (c)
Magnetic
resonance imaging of pineal region tumours. Pineal yolk sac tumour. Tumour involving the pineal gland (arrow) has slightly lobulated margins. The tumour is isointense to grey matter on sagittal T1-weighted image (a), heterogeneous with low and high signal on axial T2-weighted image (b) and shows contrast enhancement on axial T1-weighted image (c)
Magnetic
resonance imaging of pineal region tumours. Pineal embryonal carcinoma. The tumour involving the pineal gland (arrow) has lobulated margins with intermediate to high signal on axial T2-weighted image (a). The tumour shows heterogeneous contrast enhancement on sagittal T1-weighted image (b) related to its solid and cystic portions
Magnetic
resonance imaging of pineal region tumours. Pineal cyst in a 6-year-old girl causing diplopia, headache, and hydrocephalus. Axial FLAIR image (a) and sagittal T1-weighted image (b) shows a large pineal cyst (arrow) with signal that is minimally higher than CSF. Post-contrast sagittal T1-weighted image (c) shows thin peripheral enhancement of the pineal cyst wall (*) as well as minimal dependent layering of contrast within the cyst. The pineal cyst compresses the tectal plate and cerebral aqueduct resulting in obstructive hydrocephalus
Magnetic
resonance imaging of pineal region tumours. Pineal lipoma. Sagittal T1-weighted image (a) shows a well-circumscribed high signal lesion (arrow) involving the dorsal portion of the tectal plate extending into the pineal recess. The signal of this lesion is nulled on the axial fat-suppressed T1-weighted image (b) confirming the diagnosis of lipoma
Magnetic
resonance imaging of pineal region tumours. Tentorial meningioma in a 45-year-old woman with papilloedema. A meningioma (arrow) is seen involving the tentorium which extends into the pineal recess. The lesion is isointense to grey matter on axial T2-weighted image (a) and sagittal T1-weighted image (b) and shows prominent contrast enhancement on coronal T1-weighted image (c)
Magnetic
resonance imaging of pineal region tumours. Pineal melanoma in a 65-year-old woman with diplopia and worsening hearing loss. The tumour (arrow) has lobulated, circumscribed margins, and demonstrates heterogeneous predominately high signal on sagittal T1-weighted image (a), and low to intermediate signal on axial T2-weighted image (b). The tumour shows prominent contrast enhancement on axial T1-weighted image (c) as well as invasion of the medial right temporal lobe
Magnetic
resonance imaging of pineal region tumours. Primitive neuroectodermal tumour (PNET) involving the pineal gland in a 3-year-old boy. Well-circumscribed, tumour arising from the pineal gland (arrow), which has mostly intermediate signal as well as high signal foci on sagittal T1-weighted image (a) and intermediate, low and high signal on axial T2-weighted image (b). The pineal tumour demonstrates heterogeneous contrast enhancement on sagittal T1-weighted image (c). The tumour causes obstructive hydrocephalus by exerting localised mass effect and compression of the quadrigeminal plate, cerebral aqueduct and third ventricle
Central
nervous system germinoma • Pineal tumor calcification (illustration) - Ganzer Fall bei Radiopaedia
Masses in the pineal region have a relatively broad differential because of the variety of cell types found in the region.
Terminology
The term pinealoma was historically used to refer to both pineal parenchymal tumors and germinomas, which are the two most common categories of primary pineal region tumors . Germinomas were sometimes called the "two-cell" pattern type of pinealoma, due to the presence of both lymphocytes and neoplastic germ cells that were reminiscent of teratomas . The term pinealoma has since fallen in popularity.
Clinical presentation
Some lesions (such as cysts) are typically discovered incidentally but for larger lesions, patients present clinically with symptoms related to mass effect. Compression of the tectal plate may cause a defect in up-gaze (Parinaud syndrome). Compression of the cerebral aqueduct may cause obstructive hydrocephalus.
Radiographic features
Intrinsic pineal tissue masses tend to cause upward displacement of the internal cerebral veins. This is in distinction to tentorial meningiomas, which depress the cerebral veins.
Differential diagnosis
- pineal cyst (most common benign pineal region mass)
- germ cell tumors
- pineal germinoma: most common (~50% of primary pineal region tumors)
- pineal embryonal carcinoma
- pineal choriocarcinoma
- pineal yolk sac carcinoma (endodermal sinus tumor)
- pineal teratoma
- pineal parenchymal tumors (~30% of primary pineal region tumors)
- glioma (usually tectal in origin, astrocytic in histology) (~5% of primary pineal region tumors)
- pineal metastasis
- primary pineal malignant melanoma
- inclusion cysts (dermoid/epidermoid)
- meningioma near the pineal region
- rare vascular lesions
- cavernoma in the pineal region
- vein of Galen aneurysmal malformation
If invasive, a tectal plate mass may be difficult to distinguish from a pineal mass.
Siehe auch:
- Pinealiszyste
- Astrozytom
- Keimzelltumor
- Pineoblastom
- Kavernom
- Pineozytom
- Parenchymtumor der Glandula pinealis mit intermediärer Differenzierung
- Germinom der Glandula pinealis
- Nothnagel-Syndrom
- Lipom der Glandula pinealis
- Papillärer Tumor der Pinealisregion
- Dottersacktumor der Glandula pinealis
- Parenchymtumoren der Glandula pinealis
- embryonales Karzinom der Glandula pinealis
- Teratom der Glandula pinealis
und weiter:
- tektales Lipom
- intraventrikuläre Neoplasien und Läsionen
- intrakranielle Epidermoidzyste
- Germinom
- Glandula pinealis
- Hirntumoren
- Aquäduktstenose
- intraventricular epidermoid
- intrakraniale Teratome
- intraventrikuläre Neoplasien und Läsionen - Überblick
- aqueduct of Sylvius
- pineal gland metastasis
- intracranial choriocarcinoma
- Pinealisinfarkt
- Aquäduktsyndrom
- Epidermoidzyste der Glandula pinealis
- pineal region cavernoma
- mixed germ cell tumor - pineal gland
- kongenitale Aquäduktstenose
- Tumoren des Tectums
- Apoplex der Glandula pinealis
- Tectum mesencephali
- pineal lymphoma
- germinoma of the third ventricle
- pineocytoma with astrocytic differentiation
- Pinealiszyste Differentialdiagnose
- Melanom der Glandula pinealis
- pineal region mass: meningioma
- Germinom des ZNS
- intrakranieller Keimzelltumor
- intracranial germ cell tumours
Assoziationen und Differentialdiagnosen zu Tumoren der Pinealisregion:
Parenchymtumor
der Glandula pinealis mit intermediärer Differenzierung
