MS NISHA MATHEW

Pineal Gland tumor

Pineal gland The pineal gland (also called the pineal

body, epiphysis cerebri, epiphysis, conarium or the "third eye") is a small endocrine gland in the vertebrate brain. It produces the serotonin derivative melatonin,Its shape resembles a tiny pine cone (hence its name), and it is located near the centre of the brain, between the two hemispheres, tucked in a groove where the two rounded thalamic bodies join.

Pineal gland Tumor

Pineal region tumors are derived from cells located in and around the pineal gland (pinocyte & pineal parenchymal cells)

This cell is a specialized neuron related to retinal rods and cones.

Epidemiology

These tumors represent about 1% of all brain tumors but account for 3% to 8% of the intracranial tumors that occur in children.

Most children are aged 10-20 years at presentation, with the average age at presentation being 13 years.

Adults typically are older than 30 years at presentation.

Etiology

Tumors can be divided into germ cell and non–germ cell derivatives.

Most tumors are a result of displaced embryonic tissue, malignant transformation of pineal parenchymal cells, or transformation of surrounding astroglia.

No specific genetic mutations have been associated with sporadic pineal region tumors

Pathophysiology

Transformation into pineal tumor

local infiltration of neural structures Vision changes

Suppressing Aqeu duct

Increased ICP

Hydrocephalus

Clinical ManifestationsHeadacheNauseaVomiting caused by aqueductal compressionObstructive hydrocephalus. Increased ICP, Seizures, Vision changes (Inability to focus on objects,

double vision, and impairment of eye movements)LethargyObtundation In Children endocrine malfunctionHydrocephalus or concurrent suprasellar- diabetes insipidusPseudo precocious pubertyIn a large series of patients , 93% of girls older than 12

years had secondary amenorrhea 33% of patients younger than 15 years had growth arrest.

Diagnostic findings

Physical examination & Clinical historyNeurological exam: vision, hearing, balance, coordination

and reflexesCT ScanMRI ScanAngiogramX-rays of the Head and SkullMagnetic resonance spectroscopy (MRS)Single-photon emission computerized tomography

(SPECT)Positron emission tomography (PET) scanningBiopsy

Treatment

Surgery: The surgeon drills a small hole called burr

hole, into the skull. A narrow, thin needle is then inserted through the hole. Tissue is removed using the needle, which is frequently guided by CT scanning

if possible minimally invasive technique is used

For Hydrocephalus : Endoscopic third ventriculostomy or a ventricular shunt is placed

Radiation Therapy-More than 70 percent of tumors are highly

sensitive to radiation therapy.Stereotactic radiosurgeyGamma Knife

ChemotherapyCisplatin, vinblastine and bleomycinCisplatin and bleomycinVincristine, actinomycin D, and

cyclophosphamide