Tumors of the Pineal Gland Parenchyma

Tumors arising in the pineal parenchyma—the relatively benign pineocytoma (grade 2), the malignant pineo-blas-toma (grade 4), and the mixed pineocytoma/pineoblas-toma—constitute 1% of all primary intracranial tumors and 15% to 30% of all tumors in the pineal region. Clinically, these tumors are characterized as follows:

• Symptoms and signs of increased ICP are present due to occlusion of the aqueduct of Sylvius and subsequent hydrocephalus.

• Vertical gaze palsy (Parinaud syndrome), due to compression of the tectum of the midbrain.

• Hypothalamic and endocrine dysfunction, due to compression or infiltration of the wall of the third ventricle.

Pineocytoma and pineoblastoma are hypointense on T1-and hyperintense on T2-weighted images, and enhance with contrast. On CT scan, they are isodense or slightly hyperdense. Pineocytoma enhances homogenously and pineoblastoma inhomogenously. Survival with pineocy-toma averages 5 years and with pineoblastoma, 3 years.

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