Sunday, September 23, 2007

Radiology Grand Rounds-XVI




Here is a case of Pineal tumour for the Radiology Grand Rounds submitted by Dr MGK Murthy, Dr Sumer Sethi of Teleradiology Providers. Concept of the Radiology Grand Rounds is available at- Radiology Grand Rounds.



The approach to such cases--
Germinoma and teratoma are two germ cell tumors that can arise from the pineal gland. Germinoma is the most common pineal tumor, accounting for 40-50% of all pineal region tumors and two-thirds of all germ cell tumors. It affects primarily children or young adults and is significantly more common in males. Germinomas have a homogenous appearance on MRI and enhance strongly following contrast administration. Teratoma accounts for 15% of pineal masses and also demonstrates male predominance. These lesions are heterogeneous with calcifications and mixed CSF, lipid and soft tissue areas. Germ cell tumors tend to engulf primary pineal calcifications.
Pineal parenchymal lesions include pineocytoma and pineobalstoma. Pineocytoma is an enhancing lesion that affects adults. This benign entity is characterized by good demarcation, homogeneity, and slow growth. It is noninvasive. Pineoblastoma generally affects children and occurs with approximately equal incidence in males and females. Common characteristics of this malignancy include local invasion, distant CNS spread, heterogeneity, calcification, and marked enhancement. It is important to obtain images of the spine to look for metastases. Parenchymal tumors will have intrinsic calcifications, producing an exploded appearance .
The above case is a lady young and homogenous enhancement hence pineocytoma is possible.
The clinical presentation of a pineal lesion may include obstructive hydrocephalus, Parinaud's syndrome (characterized by palsy of upward gaze, dissociation of light and accommodation, and failure of convergence) caused by compression of the tectum, and endocrine abnormalities ( e.g., precocious puberty) in cases of germ cell tumors. One of the radiologist's main roles is to determine the origin of the lesion. Lesions arising from adjacent regions and extending to the pineal region include CNS lipoma, epidermoid, arachnoid cyst, astrocytoma, and meningioma. Lesions arising from the pineal gland itself include germ cell tumors, pineal parenchymal lesions, pineal cysts, vascular malformations, and metastases.

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