Merck Manual

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Pineal Region Tumors


Mark H. Bilsky

, MD, Weill Medical College of Cornell University

Reviewed/Revised May 2023
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Most pineal region tumors are germ cell tumors.

Common primary pineal region tumors include germ cell tumors:

  • Germinomas (most common)

  • Choriocarcinomas

  • Yolk-sac tumors

  • Teratomas

Less common primary pineal tumors include pineocytomas and the rare malignant pineoblastomas.

Pineal region tumors tend to occur during childhood but can occur at any age.

These tumors may increase intracranial pressure by compressing the aqueduct of Sylvius. They may also cause paresis of upward gaze and loss of pupillary light and accommodation reflexes by compressing the pretectum rostral to the superior colliculi (Parinaud syndrome). These tumors may cause precocious puberty Precocious Puberty Precocious puberty is onset of sexual maturation before the average age. Diagnosis is by comparison with population standards, x-rays of the left hand and wrist to assess skeletal maturation... read more , especially in boys, as the hypothalamus is compressed ventrally.

Diagnosis of pineal region tumors is by MRI and tissue biopsy. Lumbar puncture is usually contraindicated because herniation is a risk.

Prognosis for and treatment of pineal region tumors depend on tumor histology. Radiation therapy, chemotherapy, radiosurgery, and surgery are used alone or in combination. Germinomas are very sensitive to radiation therapy and are often cured.

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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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