Pineal Tumors and Pineal Region Lesions Flashcards
Pineal region tumors are relatively rare and are more common in children than in adults. Germinoma is the most common tumor at this location followed by astrocytoma and teratoma. Which of the following is correct regarding the boundaries of pineal region?
● A. Bounded dorsally by the splenium of the corpus callosum and tele choroidea
● B. Bounded ventrally by the quadrigeminal plate and midbrain tectum
● C. Bounded rostrally by the posterior aspect of the third ventricle
● D. Bounded caudally by the cerebellar vermis
● E. All of the above
E. All of the above
Pineal region tumor in an adult of more than 40 years of age is most likely which of the following?
● A. Germinoma
● B. Meningioma or glioma
● C. Teratoma
● D. Ependymoma
● E. Glial cyst (pineal cyst)
B. Meningioma or glioma
In order to proceed for the management of pineal region mass, MRI of brain with and without contrast is needed. MRI of cervical, thoracic, and lumbar spine with IV contrast is also needed to see any drop metastasis. Which of the following statements is incorrect regarding the treatment of pineal region tumors?
● A. Pineal cyst of less than 2-cm size must be excised with surgery
● B. If there is hydrocephalus, then transventricular biopsy should be taken to see histopathology of tumor
● C. If there is no hydrocephalus, then open biopsy or stereotactic biopsy or navigation-assisted endoscopic biopsy should be taken
● D. If the histopathology comes out to be germinoma, then treatment is radiotherapy and chemotherapy
● E. For all tumors other than germinoma, the option is resection followed by adjuvant therapy
A. Pineal cyst of less than 2-cm size must be excised with surgery
Two main stereotactic trajectories for pineal region
tumors include anterolateral (low frontal) approach below the internal cerebral vein and the second is posterolateral trans-parieto-occipital approach. Which of the following vessels is at risk of damage during pineal region surgery?
● A. Vein of Galen
● B. Basal vein of Rosenthal
● C. Internal cerebral veins
● D. Posterior medial choroidal artery
● E. All of the above
E. All of the above
The pineal gland is a neuroendocrine gland that secretes melatonin in response to photic stimulation of the retina by the bright light, and also regulates secretion of some pituitary hormones. It is outside the blood–brain barrier and is supplied by choroidal branches of the posterior cerebral artery. The tumors which are treated with surgical resection include following except?
● A. Radioresistant tumors like malignant non-germinoma GCTs
● B. Meningiomas and teratomas
● C. Pineacytoma
● D. Germinoma
● E. Well-encapsulated tumors
D. Germinoma
Among the following surgical approaches for the pineal region tumors, which is the most common?
● A. Midline infratentorial supracerebellar approach of Horsley and Krause as refined by Stein
● B. Occipital transtentorial approach
● C. Transventricular (requires dilated ventricles and large eccentric lesions)
● D. Lateral paramedian infratentorial
● E. Transcallosal
● F. Paramedian infratentorial supracerebellar approach
A. Midline infratentorial supracerebellar approach of Horsley and Krause as refined by Stein
Complications from surgery for pineal region tumors include new visual field deficits, epidural fluid collection, infection, and cerebellar ataxia. What is the surgical mortality rate of pineal region tumor surgery?
● A. 10 to 15%
● B. 15 to 20%
● C. 5 to 10%
● D. 20 to 25%
● E. 25 to 30%
C. 5 to 10%
A patient’s biopsy after operation for pineal region
tumor shows immature neuroepithelial cells with irregular hyperchromatic nuclei and a high nuclear to cytoplasm ratio, poorly defined cell borders, and a high Ki 67 index (23 to 50%). What is the most likely diagnosis in this case?
● A. Pineoblastoma
● B. Pineocytoma
● C. Parenchymal tumor of intermediate differentiation
● D. Pineoblastomacytoma
● E. All of the above
A. Pineoblastoma
What is the WHO grade of papillary tumor of papillary region?
● A. Grade 1
● B. Grade 2
● C. Grade 3
● D. Grade 4
● E. Both grades 1 and 2
E. Both grades 1 and 2
What is the ideal way of getting diagnosis of a pineal region tumor?
● A. Tumor markers
● B. Giving radiation and seeing response
● C. Taking biopsy
● D. Giving chemotherapy
● E. None of the above
C. Taking biopsy
Pineal region is the area of the brain bounded dorsally by the splenium of the corpus callosum and the tela choroidea, ventrally by the quadrigeminal plate and midbrain tectum, rostrally by the posterior aspect of the third ventricle, and caudally by which of the following?
● A. Cerebellar vermis
● B. Pons
● C. Medulla oblongata
● D. Sylvian fissure
● E. Obex
A. Cerebellar vermis
What is the most common tumor in pineal region in adults (> 40 years)?
● A. Germinoma
● B. Pineal cysts
● C. Meningioma
● D. Paraganglioma
C. Meningioma
Pineocytoma is a rare, well-differentiated tumor of the pineal parenchyma consisting of pineocytomatous rosettes of uniform cells and pleomorphic cells having gangliocytic
differentiation, and typically affects adults with average age at diagnosis of 43 years. What is the WHO grade for pineocytomas?
● A. I
● B. II
● C. III
● D. IV
● E. Not specified
A. I
Test dose radiation practice for management of pineal region masses was that if a pineal region tumor enhanced uniformly and had the classic appearance of a germinoma on MRI, a test dose of radiation was given, and if the tumor shrank then the diagnosis of germinoma was virtually certain and radiotherapy (XRT) was continued without surgery. What was the XRT dose?
● A. 2 Gy
● B. 3 Gy
● C. 4 Gy
● D. 5 Gy
● E. 10 Gy
D. 5 Gy
Pineal cysts do not require surgical removal unless they become large enough to cause obstructive hydrocephalus. What is the size at that time usually?
● A. > 2 cm
● B. > 3 cm
● C. > 4 cm
● D. > 5 cm
● E. > 1 cm
A. > 2 cm
