Neurosurgical experience with tumours of the pineal region at Clinica Puerta de Hierro

Abstract

The clinicopathological experience with 50 cases of pineal region tumours at Clinica Puerta de Hierro is presented. In this series, 88% of the patients were evaluated by CT-scan. Pineal region tumours make up approximately 0.7% of the intracranial expansive processes in the Spanish population. The largest group of lesions appearing in this localization is that of the germinomas (38%), followed by nontumoural lesions (20%) and tumours generally considered to be of the vicinity, such as meningiomas, gliomas and metastases (18%), tumours of the pineal parenchyma (14%), and non-germinoma germinal tumours (10%). In our series, in addition to an intracranial hypertension syndrome, an ophthalmological and, to a minor degree, an endocrinological syndrome predominate in germ-cell tumours, with a cerebellar syndrome appearing in gliomas of the pineal region. All the patients in the series diagnosed as having a germinoma and treated by irradiation are alive, and free of disease, after follow-up ranging from 2 to 20 years (mean: 8 years). The experience obtained with the present series supports the opinion that, in radiosensitive tumours, surgical resection adds no therapeutic benefit to treatment with radiotherapy alone. We suggest that when dealing with a tumour of the pineal region, CT-scan and clinical assessment now permit an initial selection of patients susceptible to surgery as a first therapeutic option, indicating those patients who, because they are considered to have either a "probable germinoma" or a "tumour of uncertain diagnosis", should undergo stereotaxic biopsy or trial radiotherapy and, only when this has proved a failure, should be subjected to open surgery.

Primary pineal glioblastoma: a case report

“…It is predominant in males. It occurs generally in the first two decades (6,16,18). They may appear hyperdense on CT, with a strong contrast enhancement.…”

“…MRI may show an iso or hypointense lesion on T1-weighted images and hyperintense on T2-weighted images. Other tumors arising from the glial components of the pineal gland include ganglioneuroma, ganglioglioma, meningioma, and gliomas, more frequently low-grade astrocytomas (6,18).…”

Pineal metastasis as first clinical manifestation of colorectal adenocarcinoma: case report

“…Solitary brain metastases is a rare condition and corresponds to 1% of all cerebral metastases 3 . There are 25 cases of colorectal adenocarcinoma with cerebral metastases (including this case) as first sign of the disease reported in the literature [4][5][6][7][8] .…”

“…The first case was described by Forster in 1858; it is cited by Vaquero et al 4 in his recent rewiew. Vaquero et al 4 reviewed 75 cases of pineal region metastases, and approximately half of them were solitary 4,[10][11][12][13][14] .…”

“…Vaquero et al 4 reviewed 75 cases of pineal region metastases, and approximately half of them were solitary 4,[10][11][12][13][14] . The diagnosis of solitary metastatic lesions in the pineal region prior to the identification of the primary disease is an uncommon situation especially when the primary site is a colorectal adenocarcinoma 4,5 .…”