greatly on histology. Germinomas, for example, can be cured by radiotherapy alone or in combination with chemotherapy in the majority of cases. NGGCT, however, do not have as good prognosis but, with aggressive surgical resection, high-dose chemotherapy and radiotherapy, long-term control can be achieved. Mature teratomas, which are the least common, are slow-growing and can be cured with surgery alone [16,18].

Parenchymal pineal tumors are neoplasms arising from pinealocytes and account for 0.4-1.0% of the 17,000 primary brain tumors diagnosed each year [19]. These tumors have been categorized as pineocytoma (low-grade), pineoblastoma (high-grade) and mixed [17,19]. Approximately 30-57% of pineal parenchymal tumors are pineocytomas, 23-50% are pineo-blastomas and 20% are mixed tumors [17]. The mean age of presentation for all pineal cell tumors was 22 years, ranging from 11 months to 77 years. Pineoblastoma, the more malignant variety, has been found to occur in younger populations with a mean age of 18 years [17,19]. There is no gender preference for these tumors, although a slight male predominance has been suggested in the Japanese literature [14]. Pineoblastoma is associated with bilateral retinoblastomas (trilateral retinoblastoma) and, in such, arise from germ line mutations in the retinoblastoma (Rb) gene. Pineoblastomas have similar histological and clinical behavior as PNETs [17,20] (Figure 13.4).

Other tumors that involve the pineal region include glial cell tumors (astrocytoma, ependymoma, oligodendroglioma), choroid plexus tumors, pineal cysts, meningiomas and metastases, which are rare in this region.

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