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.

Pineal tumors: Treatment and results in 24 patients at one institution

From 1979-1991, 24 patients with pineal region tumors were treated at King Faisal Specialist Hospital. Nineteen patients had histologically Verified tumors, pineal parenchymal 14, germ cell 3 and gliomas in 2 patients. Two of the 5 patients without biopsy had elevated levels of alpha fetoproteins. Surgery was performed in 20 patients. Tumor excision was complete in one patient and partial in 11 patients. Biopsy alone was done in 7 cases. Seventeen patients required a Shunting procedure, and in one patient, it was the only surgical procedure. Twenty patients received primary radiation treatment, localized radiation to the primary site 5, whole brain irradiation followed by a boost to the primary site 6 and craniospinal radiotherapy in 9 patients. The radiation doses varied between 30-55 Gy for the primary site and from 30.6-36 for the whole neuraxis. Three patients with germ cell tumors received chemotherapy. The overall 5-year actuarial survival was 42%