pineal body cyst
DESCRIPTION
Non neoplastic pineal body cystTRANSCRIPT
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Pineal Region Lesions
Mohamed Wael Samir, MDProf. of NeurosurgeryAin Shams University
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Pathology
V Vascular : Vein of Galen MalformationI Infectious : Cysticercous cystsT Trauma: A Autoimmune/inflammatory M Metabolic/toxic I Iatrogenic N Neoplastic: C NextC Congenital/familial: Pineal cystsD Degenerative :E Epileptic :F Functional :
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Neoplasms of Pineal Region Metastatic tumors (very rare) Primary tumors: from pineal tissue
Primary Pineal parenchymal tumors [PPTs] (15%) Pineocytoma (GI) Pineal parenchymal tumour of intermediate differentiation (GII/III) Pineoblastoma (GIV) Papillary tumor of the pineal (GII/III)
Germ Cell Tumors [GCTs) (70%) Pure germinoma (52%) Teratoma (192%) Mixed germ cell tumor (16%) Endodermal sinus tumor (Yolk sac tumour) (5%) Embryonal cell carcinoma (4%) Choriocarcinoma (4%)
Secondary tumors: from adjacent tissueAstrocytoma ► Hemangiopericytoma Meningioma ► Ependymoma
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Neoplasms of Pineal Region
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Adult # Pediatric Population
60% Benign
60% Malignant
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Non Neoplastic Pineal Body Cyst
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Pathogenesis
Developmental:
Degenerative:
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Epidemiology
Incidence: Up to 23% in MRI Up to 40% in autopsy
Gender: More in female
Race: Age:
Any age but mainly in adults in the fourth decade of life Risk factors:
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Macroscopic Features
Site : Size:
2mm - > 2 cm Character:
Uni-locular or multi-locular
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Microscopic Features
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Radiological Features
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Natural History
Stationary: ~ 75% (*)
Regressive: ~ 16% (*)
Progressive: ~ 8% (*)
(*) Barboriak DP et al: AJR Am J Roentgenol 2001;176:737–43
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Clinical Presentation
Asymptomatic: Compression:
Acute: Apoplexy Gradual:
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Management
Asymptomatic: Sure of diagnosis:
No intervention or follow up radiologically Not sure of diagnosis:
Follow up clinically and radiological
Symptomatic: Stable minor symptoms and signs:
Follow up clinically and radiological Progressive or major symptoms and signs
Intervention
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Reference
HERRMANN HD, WINKLER D, WESTPHAL M. Treatment oftumours of the pineal region and posterior part of the third ventricle. Acta Neurochir (Wien) 1992;116:13746
LAURE-KAMIONOWSKA M, MASLINSKA D, DEREGOWSKI K, CZICHOS E, RACZKOWSKA B. Morphology of pineal glands in human foetuses and infants with brain lesions. Folia NeuropathoI2003;41:209-15.
Jelena Bosnjak, Mislav Budisic, Draien Azman, Maja Strineka, Miljenko Crnjakovic and Vida Demarin: PINEAL GLAND CYSTS - AN OVERVIEW. Acta Clin Croat 2009; 48:355-358
KATZMAN GL, DAGHER AP, PATRONAS NJ. Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA 1999;282:36-9.
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Reference
JINKINS JR, XIONG L, REITER R]. The midline pineal "eye": MR and CT characteristics of the pineal gland with and without benign cyst formation. J Pineal Res 1995;19:64-71.
PETITCOLIN V, GARCIER JM, MOHAMMEDI R, RAVEL A, MOFID R, VIALLET JF, VANNEUVILLE G, BOYER L. Prevalence and morphology of pineal cysts discovered at pituitary MRI: review of 1844 examinations. J Radio12002;8H41-5.
MAMOURIAN AC, TOWFIGHI]. Pineal cysts: MR imaging. AJNR AmJ NeuroradioI1986;7:1081-6.
TAPP E. The histology and pathology of the human pineal gland. In: KAPPERS ]A, PEVET P, editors. The pineal gland of vertebrates including man. Amsterdam: Elsevier! North-Holland,1979:481-500.
PU Y,MAHANKALI S, HOUJ, LIJ, LANCASTERJL, GAO J-H, APPELBAUM DE, FOX PT. High prevalence of pineal cysts in healthy adults demonstrated by high-resolution, noncontrast brain MR imaging. AJNR AmJ Neuroradio12007; 28;1706-9.
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Reference
Jelena Bosnjak, Mislav Budisic, Draien Azman, Maja Strineka, Miljenko Crnjakovic and Vida Demarin: PINEAL GLAND CYSTS - AN OVERVIEW. Acta Clin Croat 2009; 48:355-358 Michael A. Fleege, Gary M. Miller, Geoffrey P. Fletcher, Jonathan S. Fain , and Bernd W. Scheithauer: Benign Glial Cysts of the Pineal Gland: Unusual Imaging Characteristics with Histologic Correlation. AJNR Am J Neuroradiol 15:16 1-166, Jan 1994 Hirato J, Nakazato Y. Pathology of pineal region tumors. J Neurooncol 2001;54:239–49 Burger PC, Scheithauer BW (eds.). Atlas of Tumor Pathology. Tumors
of the Central Nervous System. AFIP, Washington 1994; pp. 233-236 Hirato J, Nakazato Y. Pathology of pineal region tumors. J
Neurooncol 2001;54:239–49
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Reference
5. Engel U, Gottschalk S, Niehaus L, Lehmann R, May C, Vogel S, Janisch W. Cystic lesions of the pineal region – MRI and pathology. Neuroradiology 2000; 42: 399-402.
6. Fain JS, Tomlinson FH, Scheithauer BW, Parisi JE, Fletcher GP, Kelly PJ, Miller GM. Symptomatic glial cysts of the pineal gland. J Neurosurg 1994; 80: 454-460.
15. Klein P, Rubinstein LJ. Benign symptomatic glial cysts of the pineal gland: a report of seven cases and a review of the literature. J Neurol Neurosurg Psychiatry 1989; 52: 991-995.
18. Louis DN, Reifenberger G, Brat DJ, Ellison DW. Tumours: introduction and neuroepithelial tumours. In: Love S, Louis DN, Ellison DW (eds.). Greenfi eld’s Neuropathology. Edward Arnold 2008; pp. 1942-1943
19. MENA H, ARMONDA RA, RIBAS JL, ONDRA SL, RUSHING EJ. Nonneoplastic pineal cyst: a clinicopathologic study of twenty-one cases. Ann Diagn Pathol 1997;1:11-18.
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Reference
LOUIS DN, OHGAKI H, WIESTLER OD, CAVENEE WK, BURGER PC, ]OUVET A, SCHEITHAUER BW, KLEIHUES P. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007;114:97109Barboriak DP, Lee L, and Provenzale JM. Serial MRI imaging of pineal cysts: implications for natural history and follow-up. AJR Am J Roentgenol 2001;176:737–43Milroy CM, Smith CL. Sudden death due to a glial cyst of the pineal gland. J Clin Pathol 1996;49:267–69Richardson JK, Hirsch CS. Sudden, unexpected death due to pineal apoplexy. Am J Forensic Med Pathol 1986;7:64–68Y. Pu, S. Mahankali, J. Hou, J. Li, J.L. Lancaster, J.-H. Gao, D.E. Appelbaum, P.T. Fox: High Prevalence of Pineal Cysts in Healthy Adults Demonstrated by High-Resolution, Noncontrast Brain MR Imaging. AJNR Am J Neuroradiol 28:1706–09 Oct 2007
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Ain Shams University