There is a marked male predominance with a M:F of ~13:1. Most patients are 20 years or younger at the time of diagnosis.
Pineal germinomas originate from totipotent primordial germ cells and are analogous to germ cell tumours arising in the gonads. There may be elevated CSF placental alkaline-phospatase and human chorionic gonadotropin (HCG) 5.
Pineal germinomas are typically round, solid, soft tan-white mass lesions. Necrosis and haemorrhage are not commonly a feature 5.
Pineal germinomas are composed of cells with large nuclei and prominent nucleoli. Lymphocyte infiltration is a common feature, although the degree varies from case to case. Germinoma cells are positive for placental alkaline phosphatase on immunohistochemistry 5.
See main article: intracranial germ cell tumours.
Treatment and prognosis
Leptomeningeal or intraventricular spread is not uncommon (occurring in 13% 2) at the time of diagnosis. Germinomas are receptive to radiation therapy and survival rates of ~85% are reported 3.
See pineal region mass article.
- 1. Villano JL, Propp JM, Porter KR et-al. Malignant pineal germ-cell tumors: an analysis of cases from three tumor registries. Neuro-oncology. 2008;10 (2): 121-30. Neuro-oncology (full text) - doi:10.1215/15228517-2007-054 - Free text at pubmed - Pubmed citation
- 2. Fang AS, Meyers SP. Magnetic resonance imaging of pineal region tumours. Insights Imaging. 2013;4 (3): 369-82. doi:10.1007/s13244-013-0248-6 - Free text at pubmed - Pubmed citation
- 3. Reddy MP, Saad AF, Doughty KE et-al. Intracranial germinoma. Proc (Bayl Univ Med Cent). 2015;28 (1): 43-5. Free text at pubmed - Pubmed citation
- 4. Al-Hussaini M, Sultan I, Abuirmileh N et-al. Pineal gland tumors: experience from the SEER database. J. Neurooncol. 2009;94 (3): 351-8. doi:10.1007/s11060-009-9881-9 - Free text at pubmed - Pubmed citation
- 5. Hirato J, Nakazato Y. Pathology of pineal region tumors. Journal of neuro-oncology. 54 (3): 239-49. Pubmed
Pineal region masses
The pineal region is anatomically complex and plays host to a number of unique masses and tumours as well as potentially affected by many entities seen more frequently elsewhere in the brain.
- cystic non-neoplastic lesions
- pineal parenchymal tumours
- germ cell tumours
- tumours also encountered in the pineal region
- pineal gland metastases
- vascular lesions