Images below require Macromedia's Flash Player to view

Neuroradiology Case of the Week

Case 349

September 2008

Hisao Nakamura, MD

Clinical Presentation: Patient is a 43-year-old female with headaches x1 year getting worse. She also complains of worsening vision.

Imaging Findings: Pineocytoma.

Diagnosis: Pineal parenchymal tumor of intermediate differentiation

Discussion: Differential diagnosis of the pineal gland tumor includes the pineal parenchymal tumor (pineocytoma, pineoblastoma), germinoma, astrocytoma, other germ cell tumor and meningioma. Considering the findings of heterogeneous patchy enhancement, germinoma or meningioma is less likely. Because the mass is wel-defined, astrocytoma is less likely. So pineocytoma is more likely. But heterogeneous enhancement and cystic or necrotic change also make us pineoblastoma. Of course, other germ cell tumor except germinoma can not be denied. Pathology demonstrates the intermediate pineal parenchymal tumor. An intermediate neoplasm, a mixture of both mature pineocytoma and immature pineoblastoma has also been identified. The prognosis is also intermediate between the dismal outcome of pineoblastoma and the relatively more favorable outcome with pineocytoma.
     Pineal parenchymal neoplasms account for less than 15% of all pineal region masses. Unlike the germinomas, they may be found in older patients who are beyond their 2nd decade. There are basically two types that arise from the pineal cells: the pineocytoma and the pineoblastoma. In addition, however, pineal parenchymal tumors may have ganglionic and astrocytic differentiation, and various combination of these two types are possible.

References:

1. Banks KP, Brown SJ. AJR teaching file: solid masses of the pineal region. AJR Am J Roentgenol. 2006 Mar;186(3 Suppl):S233-5. [PubMed] [PDF]
2. Smirniotopoulos JG, Rushing EJ, Mena H. Pineal region masses: differential diagnosis. Radiographics. 1992 May;12(3):577-96. [PubMed]