Effects of acute hypothyroidism on plasma melatonin and Aanat and Asmt expression in the pineal gland and gonads of rats.

Introduction: The reproductive system is tightly regulated by environmental and physiological signals. Melatonin, known as the hormone of darkness, plays a crucial role in regulating both the circadian and reproductive systems in mammals. Hypothyroidism is a key endocrine disorder that harms the reproductive system. Despite many studies on melatonin's effects on the reproductive system, there is conflicting information regarding melatonin synthesis modulation in hypothyroidism. The objective of this study was to investigate the modulation of plasma melatonin levels and gene expression of Aanat and Asmt in the pineal gland and gonads of rats with hypothyroidism at different times of the day. Methods: Female and male Wistar rats were divided into control and hypothyroid groups. Hypothyroidism was induced using propylthiouracil (PTU) for 15 days, rats were euthanized six hours after lights on (ZT6), before lights off (ZT11.5), and six hours after lights off (ZT18). Free thyroxine (FT4) and melatonin were quantified in plasma, and gene expressions of melatonin synthesizing enzymes (Aanat and Asmt) were measured in pineal and sexual organs (testis and ovary). Also, morphological analysis was performed in sexual organs. Results: The results reveal some disparities between the sexes. Hypothyroidism reduced antral and primary follicles in the ovary, and reduced the weight of testis, epididymis, and prostate. In relation to gene expression, we observed a reduction in Aanat expression in the pineal gland during the light phase (ZT6), and in males, this reduction occurred during the dark phase (ZT18). Regarding Asmt expression, there was a decrease in females also during the dark phase (ZT18). In the gonads, there was an increase in expression in both sexes at ZT11.5. Additionally, it was interesting to observe the association between FT4 levels and Asmt expression in the gonads. Conclusions: This study showed that acute hypothyroidism can affect components of the melatonergic system in gonads, particularly gene expression of melatonin synthesis enzymes (Aanat and Asmt) contributing to changes in reproduction organs during disease progression. These findings enhance our understanding of melatonin synthesis in the reproductive system during hypothyroidism, showing distinct responses in male and female rats, and suggest that hypothyroidism affects the circadian rhythmicity of melatonin synthesis in a sex-dependent manner.

LPS-induced inflammation in rats during pregnancy reduces maternal melatonin and impairs neurochemistry and behavior of adult male offspring.

Inflammation during pregnancy can induce neurodevelopmental changes that affect the neurological health of offspring. Elevated levels of circulating inflammatory cytokines have been shown to decrease nocturnal melatonin synthesis by the pineal gland, potentially impacting fetal development. This study aimed to assess the effects of LPS-induced inflammation on melatonin concentrations in the plasma of pregnant female rats and explore resulting neurochemical and behavioral changes in their offspring. Our findings revealed that pregnant rats injected with LPS experienced decreased nocturnal melatonin levels in their plasma, with an increase in diurnal melatonin content. The offspring exhibited reduced performance in tests evaluating motor coordination and spatial memory compared to control subjects. Immunohistochemical analysis indicated a decline in calbindin immunoreactivity in Purkinje cells in the cerebellum. Additionally, the hippocampus displayed an increase in IBA-1 and calretinin expression, coupled with a reduction in parvalbumin expression in the offspring of the LPS group. Collectively, this study provides compelling evidence that an inflammatory state can lead to a reduction in melatonin synthesis in pregnant females, potentially impacting the neurodevelopment of offspring, including neuronal, glial, motor, and cognitive aspects. Subsequent studies will further elucidate the mechanisms underlying inflammation-induced maternal melatonin reduction and its impact on offspring neurodevelopment.

IL-10-induced STAT3/NF-κB crosstalk modulates pineal and extra-pineal melatonin synthesis.

Immune-pineal axis activation is part of the assembly of immune responses. Proinflammatory cytokines inhibit the pineal synthesis of melatonin while inducing it in macrophages by mechanisms dependent on nuclear factor-κB (NF-κB) activation. Cytokines activating the Janus kinase/signal transducer and activator of transcription (STAT) pathways, such as interferon-gamma (IFN-γ) and interleukin-10 (IL-10), modulate melatonin synthesis in the pineal, bone marrow (BM), and spleen. The stimulatory effect of IFN-γ upon the pineal gland depends on STAT1/NF-κB interaction, but the mechanisms controlling IL-10 effects on melatonin synthesis remain unclear. Here, we evaluated the role of STAT3 and NF-κB activation by IL-10 upon the melatonin synthesis of rats' pineal gland, BM, spleen, and peritoneal cells. The results show that IL-10-induced interaction of (p)STAT3 with specific NF-κB dimmers leads to different cell effects. IL-10 increases the pineal's acetylserotonin O-methyltransferase (ASMT), N-acetylserotonin, and melatonin content via nuclear translocation of NF-κB/STAT3. In BM, the nuclear translocation of STAT3/p65-NF-κB complexes increases ASMT expression and melatonin content. Increased pSTAT3/p65-NF-κB nuclear translocation in the spleen enhances phosphorylated serotonin N-acetyltransferase ((p)SNAT) expression and melatonin content. Conversely, in peritoneal cells, IL-10 leads to NF-κB p50/p50 inhibitory dimmer nuclear translocation, decreasing (p)SNAT expression and melatonin content. In conclusion, IL-10's effects on melatonin production depend on the NF-κB subunits interacting with (p)STAT3. Thus, variations of IL-10 levels and downstream pathways during immune responses might be critical regulatory factors adjusting pineal and extra-pineal synthesis of melatonin.

An atypical location of pineoblastoma RB1 subgroup without pineal or retinal tumor.

PURPOSE: To describe the clinical and imaging features of a sellar-suprasellar pineoblastoma RB1 subgroup without pineal or retinal involvement. CASE REPORT: An 11-month-old girl presented to the emergency department with fever, rhinorrhea, vomiting, altered level of consciousness, and one seizure. Head CT and brain MRI demonstrated a large lobulated mass with calcifications and heterogeneous enhancement in the suprasellar region causing mass effect to the ventricular system and hydrocephalus. Histology revealed a CNS embryonal tumor not otherwise specified (NOS) with small round nuclei with mitotic activity and necrosis. DNA methylation analysis classified the tumor in the pineoblastoma RB1 subgroup. CONCLUSION: Pineoblastoma RB1 subgroup should be considered in the differential diagnosis of large sellar-suprasellar masses with calcifications and heterogeneous enhancement in children younger than 18 months even in cases of absent pineal or retinal involvement. Molecular analysis with DNA methylation profiling is critical for diagnosis and management.

Absence of melatonin during development impairs craniofacial and dental onset in rats.

OBJECTIVE: Herein, we evaluated pinealectomy-induced melatonin absence to determine its effects on craniofacial and dental development in the offspring. DESIGN: Female Wistar rats in three groups, i.e., intact pregnant rats, pinealectomized pregnant rats (PINX), and pinealectomized pregnant rats subjected to oral melatonin replacement therapy, were crossed 30 days after surgery. The heads of 7-day-old pups were harvested for cephalometric and histological analyses, and maxillae and incisors were collected for mRNA expression analysis. RESULTS: The PINX pups exhibited a reduction in neurocranial and facial parameters such as a decrease in alveolar bone area, incisor size and proliferation, and an increase in odontoblasts and the dentin layer. Based on incisor mRNA expression analysis, we found that Dmp1 expression was upregulated, whereas Col1a1 expression was downregulated. Maxillary mRNA expression revealed that Rankl expression was upregulated, whereas that of Opn and Osx was downregulated. CONCLUSION: Our results demonstrated that the absence of maternal melatonin during early life could affect dental and maxillary development in offspring, as well as delay odontogenesis and osteogenesis in maxillary tissues. CLINICAL RELEVANCE: Our findings suggest that disruptions or a lack of melatonin during pregnancy may cause changes in craniofacial and dental development, at least in animal experiments; however, in humans, these feedings are still poorly understood, and thus careful evaluations of melatonin levels in humans need to be investigated in craniofacial alterations.

Novel pathogenic variant of DICER1 in an adolescent with multinodular goiter, ovarian Sertoli-Leydig cell tumor and pineal parenchymal tumor of intermediate differentiation.

OBJECTIVES: To present a case of a new pathogenic variant of DICER1. CASE PRESENTATION: 13-year-old female with non-toxic multinodular goiter and ovarian Sertoli-Leydig cell tumor, in whom a pineal parenchymal tumor of intermediate differentiation was diagnosed. Next-generation sequencing revealed a new germline mutation in the DICER1 gene (exon 16, c2488del [pGlu830Serfs*2] in heterozygosis), establishing the diagnosis of DICER1 syndrome. CONCLUSIONS: Mutations in the DICER1 gene cause genetic predisposition to a wide spectrum of benign or malignant tumors from childhood to adulthood.

Prognostic factors of pediatric pineal region tumors at a single institution.

PURPOSE: This study aimed to identify factors of a worse prognosis among different histological types of pineal region tumors in pediatric patients treat at a single institution in a 30-year period. MATERIAL AND METHODS: Pediatric patients (151; < 18 years of age) treated between 1991 and 2020 were analyzed. Kaplan-Meyer survival curves were created, and the log-rank test was used to compare the main prognostic factors in the different histological types. RESULTS: Germinoma was found in 33.1%, with an overall 60-month survival rate of 88%; the female sex was the only factor of a worse prognosis. Non-germinomatous germ cell tumors were found in 27.1%, with an overall 60-month survival rate of 67.2%; metastasis upon diagnosis, residual tumor, and the absence of radiotherapy were associated with a worse diagnosis. Pineoblastoma was found in 22.5%, with an overall 60-month survival rate of 40.7%; the male sex was the only factor of a worse prognosis; a tendency toward a worse outcome was found in patients < 3 years of age and those with metastasis upon diagnosis. Glioma was identified in 12.5%, with an overall 60-month survival rate of 72.6%; high-grade gliomas were associated with a worse prognosis. Atypical teratoid rhabdoid tumors was found in 3.3%, and all patients died within a 19-month period. CONCLUSION: Pineal region tumors are characterized by the heterogeneity of histological types, which exert an influence on the outcome. Knowledge of the prognostic factors for each histological types is of extreme importance to the determination of guided multidisciplinary treatment.

Arylalkylamine N-acetyltransferase (AANAT): Blue light induction, nuclear translocation, and potential role in the survival of chicken retina neuronal cells.

In vertebrates, arylalkylamine N-acetyltransferase (AANAT; EC 2.3.1.87) is the time-keeping and key regulatory enzyme in melatonin (Mel) biosynthesis. AANAT is present in the pineal gland, retina, and other regions where it is controlled by light, cyclic adenosine monophosphate (cAMP) levels, and the molecular clock. AANAT converts serotonin to N-acetyl serotonin (NAS) and the last enzyme in the pathway, hydroxy-o-methyltransferase (HIOMT), forms Mel by NAS methylation. We have previously shown that AANAT is expressed in chicken retinal ganglion cells (RGCs) during daytime at the level of mRNA and enzyme activity. Here we investigated the presence of AANAT protein and mRNA throughout development in the chicken embryonic retina as well as AANAT expression, phosphorylation, and its sub-cellular localization in primary cultures of retinal neurons from E10 embryonic retinas exposed to blue light (BL) and controls kept in the dark (D). From embryonic days 7-10 (E7-10) AANAT mRNA and protein were visualized mainly concentrated in the forming ganglion cell layer (GCL), while from E17 through postnatal days, expression was detectable all through the different retinal cell layers. At postnatal day 10 (PN10) when animals were subjected to a 12:12 h LD cycle, AANAT was mainly expressed in the GCL and inner nuclear layer cells at noon (Zeitgeber Time (ZT 6)) and in the photoreceptor cell layer at night (ZT 21). Primary cultures of retinal neurons exhibited an induction of AANAT protein when cells were exposed to BL for 1 h as compared with D controls. After BL exposure, AANAT showed a significant change in intracellular localization from the cytoplasm to the nucleus in the BL condition, remaining in the nucleus 1-2 h in the D after BL stimulation. BL induction of nuclear AANAT was substantially inhibited when cultures were treated with the protein synthesis inhibitor cycloheximide (CHD). Furthermore, the phosphorylated form of the enzyme (pAANAT) increased after BL in nuclear fractions obtained from primary cultures as compared with D controls. Finally, the knockdown of AANAT by sh-RNA in primary cultures affected cell viability regardless of the light condition. AANAT knockdown also affected the redox balance, sh-AANAT treated cultures showing higher levels of reactive oxygen species (ROS) than in the sh-control. Our results support the idea that AANAT is a BL-sensing enzyme in the inner retina of diurnal vertebrates, undergoing phosphorylation and nuclear importation in response to BL stimulation. Moreover, it can be inferred that AANAT plays a novel role in nuclear function, cell viability, and, likely, through redox balance regulation.

Microglia in Circumventricular Organs: The Pineal Gland Example.

The circumventricular organs (CVOs) are unique areas within the central nervous system. They serve as a portal for the rest of the body and, as such, lack a blood-brain barrier. Microglia are the primary resident immune cells of the brain parenchyma. Within the CVOs, microglial cells find themselves continuously challenged and stimulated by local and systemic stimuli, even under steady-state conditions. Therefore, CVO microglia in their typical state often resemble the activated microglial forms found elsewhere in the brain as they are responding to pathological conditions or other stressors. In this review, I focus on the dynamics of CVO microglia, using the pineal gland as a specific CVO example. Data related to microglia heterogeneity in both homeostatic and unhealthy environments are presented and discussed, including those recently generated by using advanced single-cell and single-nucleus technology. Finally, perspectives in the CVO microglia field are also included.Summary StatementMicroglia in circumventricular organs (CVOs) continuously adapt to react differentially to the diverse challenges they face. Herein, I discuss microglia heterogeneity in CVOs, including pineal gland. Further studies are needed to better understand microglia dynamics in these unique brain areas. .

Melatonin: A Neurotrophic Factor?

Melatonin, N-acetyl-5-hydroxytryptamine, is a hormone that synchronizes the internal environment with the photoperiod. It is synthesized in the pineal gland and greatly depends on the endogenous circadian clock located in the suprachiasmatic nucleus and the retina's exposure to different light intensities. Among its most studied functions are the regulation of the waking-sleep rhythm and body temperature. Furthermore, melatonin has pleiotropic actions, which affect, for instance, the modulation of the immune and the cardiovascular systems, as well as the neuroprotection achieved by scavenging free radicals. Recent research has supported that melatonin contributes to neuronal survival, proliferation, and differentiation, such as dendritogenesis and axogenesis, and its processes are similar to those caused by Nerve Growth Factor, Brain-Derived Neurotrophic Factor, Neurotrophin-3, and Neurotrophin-4/5. Furthermore, this indolamine has apoptotic and anti-inflammatory actions in specific brain regions akin to those exerted by neurotrophic factors. This review presents evidence suggesting melatonin's role as a neurotrophic factor, describes the signaling pathways involved in these processes, and, lastly, highlights the therapeutic implications involved.

Pinealectomy in Rats.

The pinealectomy technique consists of the surgical removal of the superficial pineal gland. This procedure allows the ablation of circulating indoles produced by this gland. Withdrawal of systemic melatonin, a pineal hormone, affects animal circadian rhythms and induces several physiological changes that are the subject of many investigations. In this chapter, we describe the pinealectomy protocol adapted to rats. We describe the animal placement on the stereotaxic fixation system, and the procedure for the pineal gland removal and animal recovery from surgery.

Pineal Microdialysis.

Pineal microdialysis is characterized by the real-time monitoring of melatonin, neurotransmitters, metabolites, and other compounds released by the pineal gland throughout 24 h. It is a technique with great advantages that allows in vivo study of the ongoing pineal gland metabolism. In this chapter, we describe the entire process of pineal microdialysis that includes probe manufacturing, surgical procedure for its implantation, and the sample collection process.

Pineal Cells Dissociation and Culture: Isolated Pinealocytes, Isolated Astrocytes, and Co-culture.

Mammalian pineal glands are composed mostly of pinealocytes, which are the melatonin secretory cells, and also importantly of glial cells in special astrocytes. With the aim of studying the interactions between pinealocytes and astrocytes, the methodologies for obtaining and maintaining isolated pinealocytes and astrocytes in culture were standardized, in addition to the co-culture of both cell types. Some works of our group were published on the interactions between isolated astrocytes and pinealocytes from the pineal gland of Wistar rats, considering the modulatory role of glutamate and angiotensin on the synthesis of melatonin. In this chapter, the methodologies for obtaining and maintaining astrocytes and pinealocytes culture as well as co-culture of these two cell types will be presented.

Pineal Gland Culture.

Pineal gland secretes the hormone melatonin at night with a circadian rhythm. The synthesis and secretion of melatonin are stimulated at night by norepinephrine released by sympathetic postganglionic neurons projecting from the superior cervical ganglia. Norepinephrine simultaneously activates α- and ß-adrenoceptors, triggering melatonin synthesis.To study the regulation of melatonin production and secretion, it is very convenient to use an ex vivo preparation. Thus, it is possible to keep intact pineal glands in culture and to study the actions of agonists, antagonists, modulators, toxic agents, etc., in melatonin synthesis. Artificial melatonin synthesis stimulation in vitro is usually achieved by using a ß-adrenergic agonist alone or in association with an α-adrenergic agonist. In this chapter, the methodology of cultured pineal glands will be described. Several papers were published by our group using this methodology, approaching the role played in melatonin synthesis control by angiotensin II and IV, insulin, glutamate, voltage-gated calcium channels, anhydroecgonine methyl ester (AEME, crack-cocaine product), monosodium glutamate (MSG), signaling pathways like NFkB, pathophysiological conditions like diabetes, etc.

Actualización sobre los tumores de la región pineal / Update on pineal region tumors

Introducción: Los tumores de la región pineal constituyen un grupo heterogéneo de lesiones agrupadas más por su localización común que por su relación histológica. Pueden clasificarse en tumores de células germinales, del parénquima pineal, embrional y de estructuras adyacentes. Objetivo: Caracterizar la fisiopatología de los tumores de la región pineal y algunos aspectos de su tratamiento. Métodos: Se realizó una revisión bibliográfica, se seleccionaron estudios relacionados con la fisiopatología de los tumores de la región pineal y su manejo. Las fuentes de información consultada fueron Google Scholar, PubMed, SciElo y Dialnet; se utilizaron los descriptores: neoplasias pineales, pinealoma, neoplasias encefálicas. Se seleccionaron 23 artículos, más del 75 por ciento son de los últimos 5 años. Desarrollo: La tasa y la velocidad de crecimiento de estas neoplasias determinan la rapidez con la que se instauran los diversos síntomas, de ahí que la presentación más común es la hidrocefalia triventricular, acompañada de dolor de cabeza, náuseas, vómitos, disminución de la actividad, somnolencia o letargo y alteraciones visuales. También se pueden observar paresias y síndromes endocrinos. El diagnóstico se basa en la exploración de marcadores tumorales en suero, líquido cefalorraquídeo, tomografía y resonancia magnética. Finalmente, la quimioterapia y la intervención quirúrgica constituyen las principales alternativas terapéuticas tras el diagnóstico de la enfermedad. Conclusiones: Este tipo de neoplasia es poco frecuente, sus manifestaciones clínicas dependen de la localización, tamaño y tipo de tumor; además, el tratamiento suele ser quirúrgico y posterior a la quimioterapia, si las características de la neoplasia lo permiten(AU)

Introduction: Tumors of the pineal region constitute a heterogeneous group of lesions better grouped by their common location than by their histological relationship. They can be classified into tumors of germ cells, pineal parenchyma, embryonal and adjacent structures. Objective: To characterize the pathophysiology of pineal region tumors and some aspects of their treatment. Methods: A literature review was carried out, we selected studies related to the pathophysiology of pineal region tumors and their management. The information sources consulted were Google Scholar, PubMed, SciELO and Dialnet; the descriptors were used pineal neoplasms, pinealoma, brain neoplasms. Twenty three articles were selected, more than 75percent are from the last 5 years. Results: The rate and speed of growth of these neoplasms determine the speed with which the various symptoms are established, hence the most common presentation is triventricular hydrocephalus, accompanied by headache, nausea, vomiting, decreased activity, drowsiness or lethargy and visual disturbances. Paresis and endocrine syndromes may also be seen. The diagnosis is based on the examination of tumor markers in serum, cerebrospinal fluid, tomography and magnetic resonance imaging. Finally, chemotherapy and surgery are the main therapeutic alternatives after diagnosis of the disease. Conclusions: This type of neoplasm is rare, the clinical manifestations depend on the location, size and type of tumor; in addition, the treatment is usually surgical and then chemotherapy, if the characteristics of the neoplasm allow so(AU)

Morphological study of the pineal gland of Alouatta belzebul / Estudo morfológico da glândula pineal de Alouatta belzebul

The pineal is a neuroendocrine gland responsible for the synthesis and release of melatonin. It is present in the brain of vertebrates, but its morphology and location vary considerably among species. For the species Alouatta belzebul, although some anatomical aspects of the nervous system have been described, there is no information on the morphology and histological composition of this gland. Thus, the present study aimed to describe the morphological, morphometric, and histological aspects of the pineal of Alouatta belzebul. Seven adult specimens were dissected from which the location of the gland in relation to the surrounding brain structures was described, and its length and width were measured. Histological slides were then prepared and stained using hematoxylin-eosin and PAS techniques. It was observed that the pineal of Alouatta belzebul is located superior and cranial to the cerebellum, superior to the superior colliculi and below the splenium of the corpus callosum and was classified as sub-callosal. It had an average length of 2.6mm and an average width of 1.14mm. Histologically the gland is composed of irregular strands of pinealocytes and gliocytes. The pinealocytes showed pigments similar to melanin.

A pineal é uma glândula neuroendócrina responsável pela síntese e liberação de melatonina. Está presente no encéfalo dos vertebrados, mas sua morfologia e localização variam consideravelmente entre as espécies. Para a espécie Alouatta belzebul, apesar de terem sido descritos alguns aspectos anatômicos do sistema nervoso, não há informações sobre a morfologia e composição histológica desta glândula. Assim, o presente estudo teve como objetivo descrever os aspectos morfológicos, morfométricos e histológicos da pineal de Alouatta belzebul. Foram dissecados sete encéfalos de espécimes adultos dos quais se descreveu a localização da glândula em relação às estruturas encefálicas circunvizinhas e foram realizadas medidas de comprimento e largura da mesma. Em seguida foram preparadas lâminas histológicas e coradas pelas técnicas de hematoxilina-eosina e PAS. Observou-se que a pineal de Alouatta belzebul localiza-se superior e cranialmente ao cerebelo, superior aos colículos superiores e abaixo do esplênio do corpo caloso e foi classificada como subcalosa. Apresentou comprimento médio de 2,6mm e largura média de 1,14mm. Histologicamente a glândula é composta por cordões irregulares de pinealócitos e gliócitos. Os pinealócitos apresentaram pigmentos semelhante à melanina.

Brain Damage-linked ATP Promotes P2X7 Receptors Mediated Pineal N-acetylserotonin Release.

The pineal gland is a key player in surveillance and defense responses. In healthy conditions, nocturnal circulating melatonin (MEL) impairs the rolling and adhesion of leukocytes to the endothelial layer. Fungi, bacteria, and pro-inflammatory cytokines block nocturnal pineal MEL synthesis, facilitating leukocyte migration to injured areas. ATP is a cotransmitter of the noradrenergic signal and potentiates noradrenaline (NAd)-induced MEL synthesis via P2Y1 receptor (P2Y1R) activation. Otherwise, ATP low-affinity P2X7 receptor (P2X7R) activation impairs N-acetylserotonin (NAS) into MEL conversion in NAd incubated pineals. Here we mimicked a focal increase of ATP by injecting low (0.3 and 1.0 µg) and high (3.0 µg) ATP in the right lateral ventricle of adult rats. Nocturnal pineal activity mimicked the in culture data. Low ATP doses increased MEL output, while high ATP dose and the P2X7R agonist BzATP (15.0-50.0 ng) increased NAS pineal and blood content. In the brain, the response was structure-dependent. There was an increase in cortical and no change in cerebellar MEL. These effects were mediated by changes in the expression of coding genes to synthetic and metabolizing melatonergic enzymes. Thus, the pineal gland plays a role as a first-line structure to respond to the death of cells inside the brain by turning NAS into the darkness hormone.

Pineal germinoma in a young adult: A case report.

BACKGROUND: Intracranial germinomas (GN) are rare cancers that primarily affect children, making them rarer still in adults. Standard treatment for this neoplasm includes neoadjuvant chemotherapy (NC) followed by radiotherapy (RT) or RT at a higher dose and larger field. These recommendations are based on studies focused mostly on children; it is currently unclear whether this treatment is applicable to adults. CASE: We present a case of a 23-year-old adult male with no underlying pathologies, drug allergies, or family history of cancer, who presented for medical evaluation with blurred vision, diplopia, forgetfulness, and weight loss starting 3-4 months before the evaluation. Clinical examination indicated Parinaud's Syndrome. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed a pineal tumor with ependymal dissemination in both lateral ventricles, which was causing obstructive hydrocephalus. The patient had surgery consisting of ventriculostomy, Holter shunt insertion, cisternal ventricular intubation, and cisterna magna anastomosis to improve ventricular drainage. Pathology confirmed pineal germinoma. Cerebrospinal fluid cytology and MRI of the axis were negative. Four cycles of NC were given to the patient (carboplatin, etoposide, and ifosfamide), with reduced dosage. Once a partial volumetric response was confirmed, whole-ventricular radiotherapy (WVR) was initiated with a total tumor bed dose of 45 Gy over 25 sessions in 5 weeks. Optimum clinical results were observed, and no short-term (<90 day) radiation toxicity was observed. The patient was able to resume his normal activities soon after treatment. Follow-ups over 2 years post-surgery indicated continued control of the lesion and absence of symptoms except for mild diplopia. CONCLUSION: Although this is a case report, these data suggest that a reduced NC course and WVR may effectively treat adult GN. This protocol likely decreases the risk of undesirable NC and RT secondary effects, while providing excellent local control; however, using a narrower RT field is not recommended.