Pineal Region Tumors

The pineal region can be affected by different types of lesions, ranging from benign masses (e.g. pineal cysts) to highly malignant tumors. These neoplasms are typical of the pediatric age, while they are rarer in adults. Due to the extreme heterogeneity of the cell types of the pineal gland and its surrounding structures, these tumors include several entities, namely germ cell tumors (GCTs), which are the most common (about 70% of the pineal region tumors, PRTs), primary parenchymal tumors (PPTs) arising from the pineal parenchyma (from pineocytoma to highly malignant pineoblastoma) and other tumors, including gliomas, metastases, and tumoral invasion of the gland by adjacent tumors (gliomas, meningiomas and others). GCTs, ependymomas and pineal cell tumors typically give “drop metastasis” through the cerebrospinal fluid (CSF). PRTs have no pathognomonic radiological features; CSF and serum markers can be helpful in this challenging differential diagnosis, which leads to different therapeutical approaches.