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Pineal Tumors

 

 

 

Investigation

History and Physical Examination:

A general history and physical examination (including a complete neurological exam) should be performed.

 

Funduscopic Exam

  • A funduscopic exam is likely to show increased intracranial pressure
  • Papilledema in as many as 90% of patients at presentation

 

CSF Cytology

  • CSF cytology is important for the staging of pineal tumors

 

Tumor Markers

  • Tumor marker testing is always part of the work up for intracranial germ cell tumors
  • β-hCG and α-fetoprotein should be measured in the blood and CSF
  • An elevated β-hCG or α-fetoprotein level of more than 100 iu/L means the presence of Non-Seminomatous Germ Cell Tumor elements 

 

Tumor cells may stain for the following tumor markers: 

Tumor Marker

Associated with:

β-hCG
  • Syncytiotrophoblast cells
  • Germinomas

α-fetoprotein
  • Yolk sac
  • Embryoma
  • Malignant teratoma
  • Not germinomas

Prolactin
  • Double midline germinoma
  • Suprasellar germinoma (secondary to decreased levels of PIF)

GFAP
  • Neuroectodermal
  • Ependymal
  • Glial

NSE (Neurone Specific Enolase)

Melatonin
  • Parenchymal pineal tumors

 

Imaging

 

Biopsy

 

 

 

 

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