Pineal region tumours

Pineal region tumours are relatively uncommon. They consist of a variety of different pathological types and as a result of the direct anatomical relationship with the third ventricle include tumours arising at this site. Less than 20% -----

actually originate from 'pineal' cells.

PATHOLOGICAL TYPES

Germinoma: the commonest pineal region tumour, malignant in nature and resembling seminoma of the testis. It adheres firmly to the surrounding tissues and cells readily spread to the floor or anterior wall of the third ventricle. Cells may also seed through the CSF pathways to the spinal cord or cauda equina.

Teratoma: well differentiated tumour occurring predominantly in males, and formed from various cell types - muscle, bone, cartilage, dermis.

Tumour consistency depends on the predominant cell type. In most patients the tumour margin is well defined. Malignant, poorly differentiated forms occasionally occur. Pineocytoma: well differentiated, slowly growing tumour j rare tumours of true

Pineoblastoma: poorly differentiated, highly malignant tumour j 'pineal' origin.

Glial cell tumours - astrocytoma - arising from cells within the pineal gland, or from adjacent brain.

ependymoma - arising from cells lining the third ventricle.

Meningioma

Dermoid f rarely occur in the pineal region. Epidermoid

CLINICAL FEATURES Develop due to:

Superior colliculus

Crus cerebri

Superior colliculus

Crus cerebri

Inferior colliculus

Superior cerebellar peduncle

Inferior colliculus

Superior cerebellar peduncle

LOCAL MASS EFFECT

Pressure on the tectal region (midbrain)

- PARINAUD'S syndrome (impaired upward gaze, pupillary abnormalities) (page 153). Compression of the aqueduct of Sylvius

- obstructive hydrocephalus with signs and symptoms of raised intracranial pressure.

EFFECTS FROM SPREAD THROUGH THE THIRD VENTRICLE

e.g. germinoma - hypothalamic damage, diabetes insipidus, hypo\hyperphagia, precocious puberty, hypopituitarism, -optic chiasmal involvement with visual field defects.

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