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Pineal Tumors




Signs & Symptoms

The clinical presentation of germ cell tumors depends on:
  • Tumor location and extent
  • Tumor size
  • Patient  age


Signs and Symptoms in Pineal tumors:

Problem Signs and symptoms
Raised Intracranial Pressure



Often due to the compression of the Sylvian aqueduct by the tumor


Increased intracranial pressure causes:

  • Headache (worse in morning)
  • Nausea and vomiting
  • On examination papilledema



Can be treated by:

  • Third ventriculostomy
  • Ventriculoperitoneal shunting (may have risk of dissemination with this)
Visual problems

Pineal gland is very close to the pretectum - eye symptoms are common 


The pretectum:

  • Includes the ocular motor centre and pupillary control centre
  • Between the thalamus and the midbrain
  • Responsible for mediating vertical eye movements


Problems with the visual pathways in pineal tumors:

  • Accommodation deficiency
  • Oculomotor nerve palsy
  • Failure of downward gaze
  • Visual field disturbance (mass effect post chiasm)
  • Lid retraction (midbrain dysfunction)
  • Pupillary abnormality


Classic problem with Pineal tumor:

  • Parinaud's Syndrome results in several different visual deficits which include:
    • paralysis of upward gaze
    • reduced pupillary reflexes to light
    • convergence paresis 
Cerebellar signs
  • Gait abnormalities, unsteadiness and frequent falls
  • Due to pressure on cerebellar peduncles
Endocrine deficits

Associated with germinomas and hypothalamic lesions 


Common deficits associated with germinoma:


Other secondary neuroendocrine deficits: 

  • Include hypopituitarism, growth failure, and elevated hCG or LH level.
  • Precocious puberty
  • Far less common to have secondary neuroendocrine deficits with non-germinoma germ cell tumors. 
  • Choriocarcinoma can be associated with sexual precocity (also may have an increase in CSF concentrations of hCG and LH).
Intracranial hemorrhage

Rare but a well-documented side effect of pineal tumors:

  • Occurs in tumors of various histological subtypes as well as in non-neoplastic masses. 
  • Bleeding may cause pineal apoplexy or subarachnoid hemorrhage. 
  • Massive hemorrhage into choriocarcinomas and endodermal sinus tumors is most frequent. 
  • Tumors of the pineal parenchyma are also very vascular. 
  • Repeated subarachnoid hemorrhage is associated with germinomas and pineocytomas. 
Non-specific neurologic deficits
  • Diplopia
  • Seizures
  • Choreoathetosis
  • Ophthalmoplegia
  • Dementia
  • Psychosis


Non-germinoma germ cell tumors tend to have localized clinical features due to pineal mass effect.


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