Pineal Region Mass – Overview

Pineal Region Mass
- Calcification
  - Diffuse or punctate
    - Pineal gland calcification
      Physiologic, especially with age.
  - Associated with solid mass
    - Pineoblastoma
      Aggressive tumour may disseminate through CSF. Peak incidence 1st decade of life.
    - Pineocytoma
      Less aggressive. Peak incidence 3rd-4th decade of life.
    - Germ Cell Tumour
      - Macroscopic fat
        
        Teratoma
        
        Mature Teratoma
        Contains well-differentiated, adult-type tissues that resembles normal tissue. Generally benign, more common in adults.
        
        Immature Teratoma
        Contains immature, embryonic, or foetal-type tissues. Higher potential for aggressive behaviour and malignancy. Fat is a less defining feature. More common in children and young adults.
      - No macroscopic fat
        
        Germinoma
        Up to 80% of intracranial GCTs. May be associated with elevated serum/plasma levels of beta-HCG or AFP.
        
        Yolk sac tumour
        May have cystic components and be associated with elevated levels of AFP.
        
        Choriocarcinoma
        High metastatic potential. Propensity to bleed. Associated with elevated levels of beta-HCG.
- Cystic Components
  - Pure cyst without solid component
    - Pineal cyst
      Often incidental, rarely causes Parinaud’s syndrome if large (>15 cm).
  - Cyst with mural nodule
    - Haemangioblastoma
      Associated with Von Hippel-Lindau disease when multiple.
  - Germinoma
    May be associated with elevated serum/plasma levels of beta-HCG or alpha-fetoprotein (AFP).
- Predominantly solid mass
  - Well-defined margins
    - Pineocytoma
      Slow-growing, less aggressive than pineoblastoma.
  - Ill-defined margins or infiltrative
    - Germinoma
      May be associated with elevated serum/plasma levels of beta-HCG or alpha-fetoprotein (AFP).
- Extension to or obstruction of nearby structures
  - Obstruction of cerebral aqueduct
    - Tectal glioma
      Low-grade glioma, often in children, causes obstructive hydrocephalus.
    - Pineoblastoma
      Aggressive tumour may disseminate through CSF. Peak incidence 1st decade of life.

Updated on 20 November 2023

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