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Pineal Tumors

 

 

 

Parenchymal Tumors

The initial approach would always involve surgery and as complete a resection as possible if deemed to be safe.

 

A comparison of Parenchymatous Pinealoma:

Pineoblastoma

Pineocytoma

Age

Young

Adult

Speed of progression

Fast

Slow

Length of illness

Short

Long

Expansion

Infiltration

Compression

Spread in CSF

Common

Rare

Cytoplasmic processes

Few

Many

Type of rosette

Homer-Wright

Pineocytomatous

Giant cells

Present

Present

Histologic variants

Subtle

conspicuous

 

Pineoblastomas

  • A type of Supratentorial Primitive Neuroectodermal Tumor (supratentorial PNET).
  • Treated with a combination of chemotherapy and RT after surgical resection if this is possible.
  • High risk medulloblastoma protocol generally used (for example - 36 Gy to the craniospinal axis with a boost to primary tumor to a total dose of 55.8 Gy in 180 cGy fractions plus concurrent chemotherapy).

 

Below is a MR scan of a 3 year old boy with a localized pineoblastoma (#1).  Treatment involved surgical resection, followed by intensive chemotherapy (and autologous transplant) and then local radiation therapy (RT). Craniospinal RT would have been associated with significant longterm morbidity.

 

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