Precocious Puberty and Pineal Cyst – An Uncommon Association.

We present a five year old boy with central precocious puberty and pineal gland cyst on neuroimaging. This association is uncommon and highlights the role of pineal gland in puberty.

Meningiomas of pineal region in children

Meningiomas are uncommon tumors in children and either more rarely encountered in the pineal region. We report two cases of meningioma of the pineal region in children. One of these cases was a five years-old girl and the other a one year-old boy. No specific clinical presentation or tomographic examinations findings was identified before treatment, suggestive of a diagnosis of menigioma. The clinical and laboratory features were very similar to the most common tumors of the pineal region. Prior to the surgery, the histology of these tumors was not suspected. Both patients underwent direct surgery and complete removal was achieved by a suboccipital transtentorial approach. The tumors originated from velum interpositum in both cases. At the follow up, one case presented with recurrence six years later, and she underwent a reoperation with total resection without morbidity. Long-term follow up presented no other recurrences.

Meningiomas são tumores poucos frequentes em crianças, e mais raramente encontrados na região da pineal. Relatamos dois casos de meningioma da região da pineal em crianças, uma menina de cinco anos e um menino de um ano de idade. Não foi identificada nenhuma forma de apresentação clinica ou caracteristica tomográfica, antes do tratamento, que sugerisse o diagnóstico de meningioma. As características clinicas e laboratoriais encontradas foram similares às de tumores mais frequentes da região da pineal. Ambos os pacientes foram submetidos ao tratamento cirúrgico e a remoção completa foi obtida por abordagem suboccipital transtentorial. Durante o seguimento, um dos pacientes foi reoperado por recorrencia do tumor seis anos após o tratamento inicial. Atualmente, os pacientes encontram-se livres de recorrência tumoral.

A Case of Pineal Ependymoma

A 64-year-old man was admitted to our hospital in semicomatous consciousness. Brain computed tomography scans demonstrated 2.6 x 2.5 cm sized hyperdense mass in the pineal region with multiple punctate calcifications and hydrocephalus. Brain magnetic resonance imaging demonstrated a pineal mass which was heterogeneously enhanced with gadolinium. After external ventricular drainage, the patient regained consciousness. The mass was totally removed via occipital transtentorial approach. No consequent ventricular shunt was needed and the patient recovered without any neurological deficit. Final pathologic report of the tumor was ependymoma.

Radiotherapy Results of pineal Tumors / 대한치료방사선과학회지

A retrospective analysis was performed on 23 patients with pineal region tumors treated with radiation from 1979 through 1985 at the Department of Therapeutic Radiology, Seoul National University Hospital, Histologic confirmation was done in only one case by surgical removal, and in the remaining 22 patients, the diagnosis was based on clinical and radiological findings. The radiation volume was the primary tumor site in 1 case, whole brain in 14 cases, and the whole craniospinal axis in 8 cases. The overall 5 year survival was 71.5%. The 5 year survival was 69. 3% for whole brain treated group and 73.3% for craniospinal axis treated group. The survival for the two groups did not differ significantly. In two cases sites of recurrence were detected. One in supratentorial area, and the other in the lung. The results from this retrospective analysis and the review of other reports indicate that routine use of prophlatic spinal irradiation is not warranted in pineal region tumor, and the craniospinal irradiation is recommended in cases with high risk for subarachnoid seeding such as positive CSF cytology, surgical removal or biopsy.