An Unusual Dermoid Cyst of the Pineal Region: Case Report in a Child

Introduction The pineal gland is a common location for intracranial germ cells, but dermoids are not commonly observed in this area. In the present paper, we discuss the clinical and radiological features as well as the treatment and outcome of this cyst in a 6-year- old child with a pineal dermoid cyst. Case Presentation The patient presented with chronic headache 6 months before admission in 2018. On the first admission, an enhanced lesion with a small cyst was detected in brain imaging. Magnetic resonance imaging (MRI) of the brain at follow-up (2 months after the first presentation) showed enlargement of the cyst size with compression on the adjacent structures. Radical excision of the tumor was performed after the endoscopic biopsy due to pressure exerted on the adjacent structures. Conclusion Dermoid cyst should be considered as a differential diagnosis for enhanced lesions of the pineal region.

Prevalence of pineal gland and choroid plexus calcification among iraqi patients attending CT scan units / Prevalencia de calcificación de la glándula pineal y del plexo coroideo entre pacientes iraquíes que asisten a las unidades de tomografía computarizada

SUMMARY: Pineal gland calcification is the most common physiological intracranial calcification followed by the choroid plexus calcification. The objective of the study was to determine the prevalence of the pineal gland and choroid plexus calcification among the Iraqi population attending computed tomography scan units in Baghdad, estimate the mean diameters of the pineal gland calcification, and to detect any correlation between these calcifications with age and sex. This multi-centric cross-sectional study examined 485 CT scans of Iraqi patients between the ages of 1 and 100 years attending CT scan units in the period 1 December 2018 to 1 April 2019. Descriptive and inferential statistics were used. The prevalence of pineal gland calcification was found to be 68 % with the 30-39 age group and male sex predominance. It was found to increase after the first decade of life without real consistency. The mean for pineal gland calcification anterior-posterior diameter was 4.55±2.13 and the mean of the right-left diameter was 3.95±1.54. These diameters were found to differ according to sex and age. Choroid plexus calcification was found to have a prevalence of 53.6 %. In most cases, choroid plexus calcification was found bilaterally (77.3 %). There was no difference in sex, but choroid plexus. In conclusion, calcification was noticed to increase gradually according to age. Both pineal gland and choroid plexus calcification have a relatively high prevalence. While pineal gland calcification formation was demonstrated to have a close relation to age and sex, choroid plexus calcification formation was noticed to relate only to age.

RESUMEN: La calcificación de la glándula pineal es la calcificación intracraneal fisiológica más común después de la calcificación del plexo coroideo. El objetivo del estudio fue determinar la prevalencia de calcificación de la glándula pineal y del plexo coroideo entre la población iraquí que asiste a las unidades de tomografía computarizada en Bagdad, estimar los diámetros medios de la calcificación de la glándula pineal y detectar la posible correlación entre estas calcificaciones con la edad y el sexo. Este estudio transversal multicéntrico examinó 485 tomografías computarizadas de pacientes iraquíes entre 1 y 100 años de edad que asistieron a unidades de tomografía computarizada en el período del 1 de diciembre de 2018 al 1 de abril de 2019. Se utilizaron estadísticas descriptivas e inferenciales. Se encontró una prevalencia de calcificación de la glándula pineal del 68 % con predominio del sexo masculino en el grupo de 30 a 39 años. Se observó que aumentaba después de la primera década de vida sin una coherencia real. La media del diámetro anteroposterior de la calcificación de la glándula pineal fue de 4,55 ± 2,13 y la media del DIÁ- METRO derecho-izquierdo fue de 3,95 ± 1,54; estos diámetros difieren según el sexo y la edad. La calcificación del plexo coroideo tiene una prevalencia del 53,6 %. En la mayoría de los casos, la calcificación del plexo coroideo se encontró de forma bilateral (77,3%). No hubo diferencia de sexo, no obstante en el plexo coroideo se observó que la calcificación aumentaba gradualmente según la edad. Tanto la calcificación de la glándula pineal como del plexo coroideo tienen una prevalencia relativamente alta. Si bien se demostró que la formación de calcificación de la glándula pineal está relacionada con la edad y el sexo, se observó que la formación de calcificación del plexo coroideo se relaciona solo con la edad.

Papillary Tumor of the Pineal Region: Case Report and Literature Review

Papillary tumor of the pineal region (PTPR) is a neuroectodermal tumor thought to originate from cells of the subcommissural organ. Its oncologic properties are still under investigation, as well as the most suitable therapeutic measures for this type of neoplasm.We report the case of a 36-year-old woman with a 1-year history of headache and intermittent diplopia. The magnetic resonance imaging (MRI) scan showed a heterogeneously enhancing mass in the pineal region that caused an acute hydrocephalus, and an emergency shunt derivation was necessary. One week later, the patient was submitted to subtotal tumor resection, and remained asymptomatic in the post-operative period. In the follow-up, the patient remained asymptomatic; in the imaging control 3.5 years after the surgical resection, local recurrence was identified, and the patient was submitted to a local radiation protocol. Our literature review showed an early clinical onset due to intracranial hypertension signs. Definitive clinical onset might be reached only through a histopathological examination. Gross total resection followed by radiotherapy is the current standard of care. Local recurrence is often observed, with rare dissemination to the cerebral spinal fluid. The natural history of the PTPR remains unknown, as well as the best treatment strategy. Large case series with longer follow-ups are necessary for further conclusions.

Resección endoscópica guiada por estereotaxia de un neurocitoma pineal: reporte de un caso / Guided stereotactic endoscopic resection of a pineal neurocytoma: a case report

El neurocitoma debe considerarse en el diagnóstico diferencial de los tumores pineales. La éxeresis quirúrgica total es esencial, y se puede realizar a través de diferentes abordajes: trans-cerebeloso, transcallosal, transcortical-Transventricular. La cirugía con puerto cerebral (brain port) es un abordaje quirúrgico que combina la resección endoscópica guiada por estereotaxia delesiones expansivas intraventriculares. Este proceder es una técnica mínimamente invasiva y es capaz de lograr la resección tumoral con mínimo daño al tejido nervioso. Reportamos un caso con un neurocitoma pineal, una paciente femenina de 29 años, Que debutó con hipertensión intracraneal secundaria a hidrocefalia obstructiva. Se logró la exéresis quirúrgica mediante brain port sin complicaciones. Los marcadores tumorales previos a la cirugía fueron negativos. El índice MIB-1 fue menor a un 4 por ciento y durante un año de seguimiento no se ha demostrado recidiva tumoral. La cirugía brain-port es una técnica segura para el abordaje a tumores de región pineal.

Neurocytoma should be considered in the differential diagnosis of pineal tumours. Total surgical resection is essential, through different approaches: transcortical-transventricular, transcallosal and transcerebellar. Brain port surgery is a surgical approach that combines endoscopic resection via stereotactic guide in intraventricular mass. This procedure is a minimally invasive technique and it is able to achieve tumour resection with minimal nervous tissue damage. We report a case with a pineal neurocytoma, a 29 years old female patient with symptoms of intracranial hypertension secondary to obstructive hydrocephalus. Total removal was done with brain port surgery without complications. Tumoral markers (AFP, CEA, HCG-ß) performed previously to surgery were negative. MIB-1 index was less than 4 percent and patient’s follow-up during one year after surgery didn’t show recurrence. Brain port surgery is considered as a safe technique to approach pineal region tumours.

Diffusion-weighted MR images and pineoblastoma: diagnosis and follow-up

Pineoblastomas are uncommon pineal tumors, which demonstrate rapid growing and poor prognosis. We report the case of a 43-year-old man with an enhancing pineal region mass, which showed restriction of the diffusion on diffusion-weighted (DW) MR images. The surgical biopsy defined the diagnosis of pineoblastoma and the therapy was initiated with radiation and chemotherapy. Three months later, the follow-up MR imaging showed areas suggestive of necrosis and the DW images demonstrate no significant areas of restricted diffusion. The differential diagnosis of pineal region masses that could show restriction of diffusion is discussed.

Pineoblastomas são tumores incomuns da glândula pineal, os quais têm crescimento rápido e prognóstico reservado. Os autores objetivam relatar o caso de um homem de 43 anos de idade com uma massa na região pineal com realce pelo contraste, a qual demonstrou restrição da difusão nas imagens de ressonância magnética (RM) pesadas em difusão. A biópsia cirúrgica definiu o diagnóstico de pineoblastoma e o tratamento foi iniciado com radio e quimioterapia. Três meses mais tarde, a RM de controle demonstrou áreas sugestivas de necrose e não mais eram observadas áreas de restrição da difusão da água. O diagnóstico diferencial das massas na região pineal que podem apresentar restrição da difusão é discutido.

Mixed germ cell tumours of the pineal region

Intracranial mixed germ cell tumours, particularly with the occurrence of germinoma and teratoma components, are very rare. On many occasions, the diagnosis is only reached after a second surgical resection of what is believed to be a tumour recurrence. The authors report two young adolescent males who presented with headache, vomiting and Parinaud's syndrome. Cranial CT and MRI scans demonstrated a large heterogeneous pineal region tumour. Through a supracerebellar infratentorial approach, in both patients, a complete excision of the tumour was achieved of a histopathologically proven mixed germ cell tumour, predominantly teratoma with elements of germinoma. The patients received adjuvant chemotherapy and radiotherapy and remained tumour free during their follow-up. The authors discuss the management of this rare entity and emphasize the importance of detailed histopathological examination

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.

Pineal yolk sac tumor: correlation between neuroimaging and pathological findings

A 17-year-old boy presented with somnolence and mental confusion. Physical examination demonstrated motor disturbances. Laboratorial investigation showed elevated levels of alpha-fetoprotein in serum and cerebrospinal fluid. The CT scan revealed a heterogeneous mass at the pineal region. At the MRI, this lesion was hypointense on T1 and hyperintense on T2-weighted images, enhancing after contrast administration. The patient underwent a surgical biopsy, which defined the diagnosis of yolk sac tumor. We emphasize the correlation of neuroimaging and pathological findings of this rare pineal region tumor.

Um menino de 17 anos de idade apresentou-se com sonolência e confusão mental. O exame físico demonstrou distúrbios motores. A investigação laboratorial revelou aumento dos níveis de alfafetoproteína no soro e no líquor. A TC de crânio revelou massa heterogênea na região pineal. A RM, a lesão era hipointensa em T1 e hiperintensa em T2, com realce após a administração de contraste. O paciente foi submetido a biópsia cirúrgica, a qual definiu o diagnóstico de tumor do seio endodérmico. Enfatizamos a correlação entre os achados patológicos e de neuroimagem deste raro tumor da região pineal.

Central neurocytomas of uncommon locations: report of two cases / Localizações incomuns do neurocitoma central: relato de dois casos

We report two patients with central neurocytomas at an uncommon location in the brain. The first, a 58-year-old man presenting with signs and symptoms of increased intracranial pressure, had a tumor located at the pineal region. The second, a 21-year-old woman with tumor in the aqueductal region had worsening migraine-like headaches and diplopia. Both patients had obstructive hydrocephalus treated by neuroendoscopic third ventriculostomy and biopsy of the tumors. No additional treatment was done. We conclude that neurocytomas should be considered in the differential diagnosis of tumors located in the pineal and aqueductal regions.

Relatamos dois pacientes com neurocitoma central com localização incomum no sistema nervoso central. O primeiro, 58 anos, masculino, apresentava sinais e sintomas de hipertensão intracraniana, tinha um tumor na região da pineal. O segundo, feminino, 21 anos, tinha um tumor na região do aqueduto de Sylvius e apresentava cefaléia migranosa progressiva e diplopia. Ambos apresentavam hidrocefalia obstrutiva tratada com terceiroventriculostomia endoscópica e biópsia da lesão. Não foi feito tratamento adicional. Concluimos que os neurocitomas devem ser considerados no diagnóstico diferencial de tumores localizados na região da pineal e do aqueduto.

Radiological approach for pineal region masses

Thirty-two pineal and related tumors were diagnosed by computed tomography [CT] and magnetic resonance imaging [MRI]. Pineal region tumors were classified as germ-cell tumors, glial tumors, pineal parenchymal tumors and cysts. They demonstrated different MR signal characteristics on pre-contrast scans and nodular or ring type enhancement with occasional central lucencies, except for benign cysts which have not shown any enhancement. MR images were useful in defining the relationship of the tumor to the posterior third ventricle, Sylvian aqueduct, vein of Galen and tentorium. Although CT can demonstrate more evident fashion displacement of the original pineal calcification as well as tumor calcifications, MR imaging demonstrates different signal characteristics in germinomas and pineoblastomas which can be a useful adjunct in the evaluation and differential diagnosis of these tumors. There were eight germinomas, four primary pineal tumors, two embryonal cell carcinomas and choriocarcinoma, five teratoma, two primitive neuroectodermal tumor, four astrocytomas, two lipomas, four meningiomas and one pineal cyst

Parinaud syndrome from tuberculoma of pineal area

Computerised tomography and magnetic resonance imaging [MRI] revealed obstructive hydrocephalus and a pineal mass in a 44-year-old woman who presented with headaches and Parinaud's syndrome. Although there was no major evidence of extracranial tuberculosis, and cerebrospinal fluid obtained during third ventriculostomy contained no leukocytes, stereotactic biopsy of the lesion revealed it to be a tuberculoma. MRI showed resolution of the lesion following antituberculous therapy. The implications of this case with regard to difficulties in the diagnosis of cerebral tuberculoma and the management of pineal region tumours are discussed

Ganglioglioma da regiäo da pineal: relato de caso / Ganglioglioma of the pineal region: case report

Os gangliogliomas são neoplasias mistas, compostas de elementos gliais e neuronais, extremamente raros na região da glândula pineal. Na presente revisão da literatura foram encontrados oito casos publicados. Apresentamos o caso de paciente de 14 anos, masculino, com ganglioglioma da região da pineal, tratado cirurgicamente, com exérese total da lesão por via suboccipital transtentorial. O estudo histológico mostrou tratar-se de ganglioglioma grau I, confirmado por imuno-histoquímica. Conclui-se que tais tumores são raros e que se deve optar pela cirurgia, objetivando a exérese total. Quando isso não for possível, ou no caso de recorrência, o paciente deve ser acompanhado clínica e radiograficamente, considerando-se a radioterapia como tratamento complementar.

Histological study on the effect of aging on the pineal gland of male albino rat

In the present study, it was found that the pineal gland of male albino rat consists of three types of cells; light pinealocytes, dark pinealocytes and neuroglial cells. The light cells are the dominant type of cells, their nuclei are large rounded and vesicular. They have slightly basophilic granular cytoplasm with one or two cellular processes. The dark cells are characterized by more basophilic cytoplasm. The neuroglial cells are smaller in size with deeply stained nuclei and the cytoplasm has numerous irregular large processes. In EM it was found that the light and dark cells have large nuclei with abundant euchromatin and prominent nucleoli. The cytoplasm of dark cells is more electron dense and both types contain abundant RER around the nucleus, large Golgi, many ribosomes, few lipid droplets and neurofilaments. There is a cell-to-cell contact at many sites. Both types of cells were considered active secretary cells. The neuroglial cells have irregular outlines and many branches that extend to surround the pinealocytes. The nucleus is large, dense and contains clumps of heterochromatin. With increasing age, there was an increase in the size of the cells. The pinealocyte nuclear membrane becomes deeply indented and the cytoplasm become more electron lucent and rarify from most of the all organoids except few mitochondria. The lipid contents increased. There was a deposition of many electron dense concretions both inter and intracellularly. The chemical nature of these concretions requires more histochemical studies. The neuroglial cells became very large in size and their cytoplasm became vacuolated. All the previous histological and ultras true tural changes of aged pineal gland of male albino rat represent a decline in the secretary activity of the gland

Estudo por ressonância magnética da regiäo da pineal: pineal normal e cistos simples / Magnetic resonance study of the pineal region: normal pineal gland and simple cysts

Realiza-se um estudo por ressonância magnética da pineal normal e dos cistos simples da pineal e estabelece-se um protocolo para estudo da regiao pineal analisando-se 762 exames. A utilizaçao da técnica com cortes finos (3 milímetros no máximo) identifica a pineal normal na maioria das vezes (84,4 por cento) e demonstra que a pineal normal, sem cistos, apresenta sinal isointenso em TI e T2 com realce após a injeçao de gadolínio, medindo em média 6,1 milímetros no seu maior diâmetro. Os cistos simples da pineal aparecem com frequência de 2,6 por cento em relaçao a toda a série (762 casos) elevando-se essa frequência para 6,1 por cento se forem consideradas somente as pineais visibilizadas (329 casos). Os cistos simples nao se correlcionam nem com a idade nem com o sexo e os cistos sintomáticos sao raros. Os critérios para diagnóstico diferencial dos cistos simples versus tumores da regiao da pineal sao: dimensoes menores ou iguais a 20 milímetros; espessura da parede abaixo de 2 milímetros; ausência de efeito expansivo; sinal igual ao líquido cefalorraquidiano e ausência de crescimento dos cistos.

Germinoma da glândula pineal / Pineal gland germinoma

Os autores apresentam um caso de germinoma da glândula pineal tratado por remoçao cirúrgica e radioterapia. Os tumores da pineal ocupam um segmento relativamente pequeno, aproximadamente 0,5 por cento dos tumores intracranianos. Sao discutidas as características clínicas, patológicas e cirúrgicas e tratamento complementar com radioterapia.

Tumores de la región pineal: comunicación de dos casos / Tumores of the pineal región: report of 2 cases

Se presentan dos casos de tumores de la región pineal estudiados en el Servicio de Neurocirugía del Hospital "Miguel Pérez Carreño", entre 1981 y 1987. De un total de docientos cinco tumores cerebrales atendidos en nuestro Servicio, corresponden a un 0.9% los de la región pineal. Ambos casos corresponden a pacientes masculinos con sindrome de hipertensión endocraneana, sindrome de Parinaud e hidrocefalia obstructiva. El tratamiento realizado consistió en una derivación ventriculo-peritoneal (D.V.P.) como primera medida terapéutica en ambos casos. Al primero se le realizó una resección macroscópica total con rayos laser y técnicas convencionales, seguido de radioterapia en el postoperatorio. El segundo caso fue tratado con radioterapia solamente. Se discuten las lesiones tumorales de la región pineal considerando la cirugía y/o radioterapia como medidas terapéuticas

Estudo histoquímico da inervaçäo do orgäo pineal de Crypturellus parvirostris (aves: tinamiformes) / Histochemical study of the innervation of pineal organ in Crypturellus parvirostris (aves: tinamiformes)

Estudou-se histoquimicamente a inervaçäo do órgäo pineal de Crypturellus parvirostris, utilizando-se a técnica da fluorescência induzida pelo ácido glioxílico para a inervaçäo adrenérgica e a técnica de Karnovsky e Roots, tendo como inhibidores ISO-OMPA e BW284C51 para demonstraçäo de colinesterases. Observou-se que a pineal destas aves possui uma inervaçäo adrenérgica bem desenvolvida e uma inervaçäo acetilcolinesterase positiva menos abundante. Através da simpatectomia química promovida pela 6-hidroxidopamina demonstrou-se que maioria da fibras acetilcolinesterase positivas säo fibras adrenérgicas. Existe entretanto um pequeno componente de fibras acetilcolinesterase positivas que näo säo destruídas pela simpatectomia química. Estas fibras juntamente com neurônios ganglionares acetilcolinesterase positivo na cápsula da pineal, com toda probabilidade, säo de natureza parassimpática

La importancia de la tomografía computada en las lesiones de la glándula pineal / Importance of computed tomography in pineal gland lesions

Los autores hacen una amplia revisión de la anatomía, fisiología y la patología de la región pineal. Informan 13 tumores pineales encontrados en una serie de 13,000 estudios de Tomografía Computada (TC) entre mayo de 1976 y diciembre de 1983 en el Instituto Nacional de Neurología y analizan sus principales caracteres. Refieren la utilidad de la TC y la correlacionan con otros estudios radiológicos