Fact-sheet: Pineal germinome


Updated on 08/26/2020 at 2:40 PM

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Definition

Tumor in the pineal gland region affecting young adults.
Frequent dissemination via cerebrospinal fluid pathways into extraparenchymal pericerebral and perimedullary spaces.
Involvement of the pituitary stalk is often associated.

Clinical features

  • Strong male predominance (13M / 1F)
  • Intracranial hypertension
  • Endocrine or visual disturbances
  • Diabetes insipidus
  • Precocious puberty

Laboratory findings

  • Beta-HCG and alpha-fetoprotein sometimes elevated.

CT

  • Well-defined homogeneous lesion
  • Iso- / hyperdense lesion.
  • No tumor calcification. Calcifications are often pre-existing to the tumor (calcifications of the pineal gland).

MRI

  • T1: isointense
  • T2: hyperintense or isointense, heterogeneous.
  • After gadolinium injection: intense, homogeneous enhancement
  • Diffusion: b1000 hyperintensity, diffusion restriction reflecting lesional hypercellularity
  • Spectroscopy: Elevated choline, decreased NAA, and +/- lactate

Differential diagnosis

  • Pineocytoma
  • Pineoblastoma
  • Neuroepithelial tumor