Pineal Tumors

http://emedicine.medscape.com/article/249945-overview

Pineal Tumors
Author: Jeffrey N Bruce, MD; Chief Editor: Allen R Wyler, MD more... Updated: Aug 27, 2010

Background
The pineal gland develops during the second month of gestation as a diverticulum in the diencephalic roof of the third ventricle. It is flanked by the posterior and habenular commissures in the rostral portion of the midbrain directly below the splenium of the corpus callosum. The velum interpositum is found rostral and dorsal to the pineal gland and contains the internal cerebral veins, which join to form the vein of Galen. Pineal region tumors are derived from cells located in and around the pineal gland. The principle cell of the pineal gland is the pineal parenchymal cell or pinocyte. This cell is a specialized neuron related to retinal rods and cones. The pinocyte is surrounded by a stroma of fibrillary astrocytes, which interact with adjoining blood vessels to form part of the blood-pial barrier. The pineal gland is richly innervated with sympathetic noradrenergic input from a pathway that originates in the retina and courses through the suprachiasmatic nucleus of the hypothalamus and the superior cervical ganglion. Upon stimulation, the pineal gland converts the sympathetic input into hormonal output by producing melatonin, which has regulatory effects upon hormones such as luteinizing hormone and follicle-stimulating hormone. The pineal gland is a neuroendocrine transducer that synchronizes hormonal release with phases of the light-dark cycle by means of its sympathetic input. However, the exact relationship between the pineal gland and human circadian rhythm remains unclear and is an active area of investigation. Some images of pineal tumors are below.

Gadolinium-enhanced MRI of a 33-year-old woman who presented with visual loss, amenorrhea, and diabetes insipidus. MRI shows germinomatous invasion of the pineal gland (large arrowhead), optic chiasm (long arrow), pituitary stalk (small arrowhead), and floor of the third ventricle (short arrow).

Noncontrast MRI of a pineocytoma in a 40-year-old man presenting with acute hydrocephalus. At surgery, the high signal area (arrow) turned out to be acute hemorrhage.

1 trong 8

11/14/2011 8:55 PM

Pineal Tumors

http://emedicine.medscape.com/article/249945-overview

MRI of a 21-year-old man with a germinoma in the pineal region. This T1-weighted noncontrast sagittal scan shows isointense tumor, which has obstructed the aqueduct of Sylvius (arrow) to cause hydrocephalus.

Contributor Information and Disclosures

Author Jeffrey N Bruce, MD Edgar M Housepian Professor of Neurological Surgery Research, Vice-Chairman and Professor of Neurological Surgery, Director of Brain Tumor Tissue Bank, Director of Bartoli Brain Tumor Laboratory, Department of Neurosurgery, Columbia University College of Physicians and Surgeons Jeffrey N Bruce, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Neurological Surgeons, American Society of Clinical Oncology, Congress of Neurological Surgeons, New York Academy of Sciences, North American Skull Base Society, Pituitary Society, Society for Neuro-Oncology, and Society of Neurological Surgeons Disclosure: NIH Grant/research funds Other Coauthor(s) Benjamin Kennedy Columbia University College of Physicians and Surgeons Disclosure: Nothing to disclose. Alfred T Ogden, MD Assistant Professor, Department of Neurological Surgery, Columbia University Medical Center Alfred T Ogden, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, and Congress of Neurological Surgeons Disclosure: Nothing to disclose. Richard CE Anderson, MD Assistant Professor of Neurosurgery and Pediatric Neurosurgery, Columbia University Medical Center, Columbia University College of Physicians and Surgeons; Director, Pediatric Neurosurgery, St Joseph's Children's Hospital Richard CE Anderson, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Association of Pediatrics, American College of Surgeons, Congress of Neurological Surgeons, and Phi Beta Kappa Disclosure: Nothing to disclose. Specialty Editor Board Michael G Nosko, MD, PhD Associate Professor of Surgery, Chief, Division of Neurosurgery, Medical Director, Neuroscience Unit, Medical Director, Neurosurgical Intensive Care Unit, Director, Neurovascular Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School Michael G Nosko, MD, PhD is a member of the following medical societies: Academy of Medicine of New Jersey, Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, Canadian Congress of Neurological Sciences, Congress of Neurological Surgeons, New York Academy of Sciences, and Society of Critical Care Medicine Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College

2 trong 8

11/14/2011 8:55 PM

Pineal Tumors

http://emedicine.medscape.com/article/249945-overview

of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Allen R Wyler, MD Former Medical Director, Northstar Neuroscience, Inc Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons Disclosure: Nothing to disclose. Paolo Zamboni, MD Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences Disclosure: Nothing to disclose. Chief Editor Allen R Wyler, MD Former Medical Director, Northstar Neuroscience, Inc Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons Disclosure: Nothing to disclose. Acknowledgments The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Andrew T Parsa, MD, PhD, and Chris E Mandigo, MD.

References
1. Van Wagenen WP. A surgical approach for removal of certain pineal tumors: Report of a case. Surg Gynecol Obstet. 1931;53:216. 2. Torkildsen A. Should extirpation be attempted in cases of neoplasms in or near the third ventricle of the brain? Experiences with a palliative method. Journal of Neurosurgery. 1948;5:269. 3. Ringertz N, Nordenstam H, Flyger G. Tumors of the pineal region. J Neuropathol Exp Neurol. Oct 1954;13(4):540-61. [Medline]. 4. Russell DS, Rubinstein LJ. Tumours and tumour-like lesions of maldevelopmental origin. In: Russel DS, Rubenstein LJ, eds. Pathology of tumours of the nervous sys. Baltimore, Md: Williams & Wilkins; 1989:664-765. 5. Ashley DM, Longee D, Tien R, et al. Treatment of patients with pineoblastoma with high dose cyclophosphamide. Med Pediatr Oncol. Jun 1996;26(6):387-92. [Medline]. 6. Fuller BG, Kapp DS, Cox R. Radiation therapy of pineal region tumors: 25 new cases and a review of 208 previously reported cases. Int J Radiat Oncol Biol Phys. Jan 1 1994;28(1):229-45. [Medline]. 7. Manera L, Regis J, Chinot O, et al. Pineal region tumors: the role of stereotactic radiosurgery. Stereotact Funct Neurosurg. 1996;66 Suppl 1:164-73. [Medline]. 8. Regis J, Bouillot P, Rouby-Volot F, et al. Pineal region tumors and the role of stereotactic biopsy: review of the mortality, morbidity, and diagnostic rates in 370 cases. Neurosurgery. Nov 1996;39(5):907-12; discussion 912-4. [Medline]. 9. Kreth FW, Schtz CR, Pagenstecher A, et al. Stereotactic management of lesions of the pineal region. Neurosurgery. Aug 1996;39(2):280-9; discussion 289-91. [Medline]. 10. Ferrer E, Santamarta D, Garcia-Fructuoso G, et al. Neuroendoscopic management of pineal region tumours. Acta Neurochir (Wien). 1997;139(1):12-20; discussion 20-1. [Medline].

3 trong 8

11/14/2011 8:55 PM

Pineal Tumors

http://emedicine.medscape.com/article/249945-overview

11. Pople IK, Athanasiou TC, Sandeman DR, Coakham HB. The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumours. Br J Neurosurg. Aug 2001;15(4):305-11. [Medline]. 12. Gangemi M, Maiuri F, Colella G, Buonamassa S. Endoscopic surgery for pineal region tumors. Minim Invasive Neurosurg. Jun 2001;44(2):70-3. [Medline]. 13. Oi S, Kamio M, Joki T, Abe T. Neuroendoscopic anatomy and surgery in pineal region tumors: role of neuroendoscopic procedure in the 'minimally-invasive preferential' management. J Neurooncol. Sep 2001;54(3):277-86. [Medline]. 14. Choi JU, Kim DS, Chung SS, et al. Treatment of germ cell tumors in the pineal region. Childs Nerv Syst. Jan-Feb 1998;14(1-2):41-8. [Medline]. 15. Sawamura Y, de Tribolet N, Ishii N, et al. Management of primary intracranial germinomas: diagnostic surgery or radical resection?. J Neurosurg. Aug 1997;87(2):262-6. [Medline]. 16. Dandy WE. Operative experience in cases of pineal tumor. Archives of Surgery. 1936;33:19-46. 17. Stein BM, Bruce JN. Surgical management of pineal region tumors (honored guest lecture). Clin Neurosurg. 1992;39:509-32. [Medline]. 18. Ahmed SR, Shalet SM, Price DA, Pearson D. Human chorionic gonadotrophin secreting pineal germinoma and precocious puberty. Arch Dis Child. Sep 1983;58(9):743-5. [Medline]. [Full Text]. 19. Allen JC, Nisselbaum J, Epstein F, et al. Alphafetoprotein and human chorionic gonadotropin determination in cerebrospinal fluid. An aid to the diagnosis and management of intracranial germ-cell tumors. J Neurosurg. Sep 1979;51(3):368-74. [Medline]. 20. Anan M, Ishii K, Nakamura T, Yamashita M, Katayama S, Sainoo M, et al. Postoperative adjuvant treatment for pineal parenchymal tumour of intermediate differentiation. J Clin Neurosci. Nov 2006;13(9):965-8. [Medline]. 21. Arita N, Ushio Y, Hayakawa T, et al. Serum levels of alpha-fetoprotein, human chorionic gonadotropin and carcinoembryonic antigen in patients with primary intracranial germ cell tumors. Oncodev Biol Med. 1980;1(4-5):235-40. [Medline]. 22. Avizonis VN, Fuller DB, Thomson JW, et al. Late effects following central nervous system radiation in a pediatric population. Neuropediatrics. Oct 1992;23(5):228-34. [Medline]. 23. Baehring J, Vives K, Duncan C, Piepmeier J, Bannykyh S. Tumors of the posterior third ventricle and pineal region: ependymoma and germinoma. J Neurooncol. Nov 2004;70(2):273-4. [Medline]. 24. Bendersky M, Lewis M, Mandelbaum DE, et al. Serial neuropsychological follow-up of a child following craniospinal irradiation. Dev Med Child Neurol. Dec 1988;30(6):816-20. [Medline]. 25. Bjornsson J, Scheithauer BW, Okazaki H, et al. Intracranial germ cell tumors: pathobiological and immunohistochemical aspects of 70 cases. J Neuropathol Exp Neurol. Jan 1985;44(1):32-46. [Medline]. 26. Bodensteiner JB, Schaefer GB, Keller GM. Incidental pineal cysts in a prospectively ascertained normal cohort. Clin Pediatr (Phila). May 1996;35(5):277-9. [Medline]. 27. Borit A. History of tumors of the pineal region. Am J Surg Pathol. Sep 1981;5(6):613-20. [Medline]. 28. Brownstein S, de Chadarvian JP, Little JM. Trilateral retinoblastoma. Report of two cases. Arch Ophthalmol. Feb 1984;102(2):257-62. [Medline]. 29. Bruce DA, Allen JC. Tumor staging for pineal region tumors of childhood. Cancer. Oct 1 1985;56(7 Suppl):1792-4. [Medline]. 30. Bruce J, Stein B. Supracerebellar approaches in the pineal region. In: Apuzzo M, ed. Brain Surgery: Complication Avoidance and Management. New York, NY: Churchill Livingstone; 1993:511-536. 31. Bruce J, Tamarkin L, Riedel C, et al. Sequential cerebrospinal fluid and plasma sampling in humans: 24-hour melatonin measurements in normal subjects and after peripheral sympathectomy. J Clin Endocrinol Metab. Apr 1991;72(4):819-23. [Medline].

4 trong 8

11/14/2011 8:55 PM

Pineal Tumors

http://emedicine.medscape.com/article/249945-overview

32. Bruce JN. Management of pineal region tumors. Neurosurgery Quarterly. 1993;3:103-119. 33. Bruce JN, Ogden AT. Surgical strategies for treating patients with pineal region tumors. J Neurooncol. Aug-Sep 2004;69(1-3):221-36. [Medline]. 34. Bruce JN, Stein BM. Pineal tumors. Neurosurg Clin N Am. Jan 1990;1(1):123-38. [Medline]. 35. Bruce JN, Stein BM. Surgical management of pineal region tumors. Acta Neurochir (Wien). 1995;134(3-4):130-5. [Medline]. 36. Burres KP, Hamilton RD. Pineal apoplexy. Neurosurgery. Mar 1979;4(3):264-8. [Medline]. 37. Calaminus G, Bamberg M, Baranzelli MC, et al. Intracranial germ cell tumors: a comprehensive update of the European data. Neuropediatrics. Feb 1994;25(1):26-32. [Medline]. 38. Calaminus G, Bamberg M, Jrgens H, Kortmann RD, Srensen N, Wiestler OD, et al. Impact of surgery, chemotherapy and irradiation on long term outcome of intracranial malignant non-germinomatous germ cell tumors: results of the German Cooperative Trial MAKEI 89. Klin Padiatr. May-Jun 2004;216(3):141-9. [Medline]. 39. Camins MB, Schlesinger EB. Treatment of tumours of the posterior part of the third ventricle and the pineal region: a long term follow-up. Acta Neurochir (Wien). 1978;40(1-2):131-43. [Medline]. 40. Chang T, Teng MM, Guo WY, et al. CT of pineal tumors and intracranial germ-cell tumors. AJR Am J Roentgenol. Dec 1989;153(6):1269-74. [Medline]. 41. Chernov MF, Kamikawa S, Yamane F, Ishihara S, Kubo O, Hori T. Neurofiberscopic biopsy of tumors of the pineal region and posterior third ventricle: indications, technique, complications, and results. Neurosurgery. Aug 2006;59(2):267-77; discussion 267-77. [Medline]. 42. Cuccia V, Rodrguez F, Palma F, et al. Pinealoblastomas in children. Childs Nerv Syst. Jun 2006;22(6):577-85. [Medline]. 43. Dattoli MJ, Newall J. Radiation therapy for intracranial germinoma: the case for limited volume treatment. Int J Radiat Oncol Biol Phys. Aug 1990;19(2):429-33. [Medline]. 44. Dempsey PK, Kondziolka D, Lunsford LD. Stereotactic diagnosis and treatment of pineal region tumours and vascular malformations. Acta Neurochir (Wien). 1992;116(1):14-22. [Medline]. 45. Deshmukh VR, Smith KA, Rekate HL, Coons S, Spetzler RF. Diagnosis and management of pineocytomas. Neurosurgery. Aug 2004;55(2):349-55; discussion 355-7. [Medline]. 46. Di Costanzo A, Tedeschi G, Di Salle F, Golia F, Morrone R, Bonavita V. Pineal cysts: an incidental MRI finding?. J Neurol Neurosurg Psychiatry. Feb 1993;56(2):207-8. [Medline]. [Full Text]. 47. Dudgeon J, Lee WR. The trilateral retinoblastoma syndrome. Trans Ophthalmol Soc U K. 1983;103 ( Pt 5):523-9. [Medline]. 48. Edwards MS, Hudgins RJ, Wilson CB, et al. Pineal region tumors in children. J Neurosurg. May 1988;68(5):689-97. [Medline]. 49. Erlich SS, Apuzzo ML. The pineal gland: anatomy, physiology, and clinical significance. J Neurosurg. Sep 1985;63(3):321-41. [Medline]. 50. Fain JS, Tomlinson FH, Scheithauer BW, et al. Symptomatic glial cysts of the pineal gland. J Neurosurg. Mar 1994;80(3):454-60. [Medline]. 51. Felix I, Becker LE. Intracranial germ cell tumors in children: an immunohistochemical and electron microscopic study. Pediatr Neurosurg. 1990-1991;16(3):156-62. [Medline]. 52. Fetell MR, Bruce JN, Burke AM, et al. Non-neoplastic pineal cysts. Neurology. Jul 1991;41(7):1034-40. [Medline]. 53. Fetell MR, Stein BM. Neuroendocrine aspects of pineal tumors. Neurol Clin. Nov 1986;4(4):877-905. [Medline].

5 trong 8

11/14/2011 8:55 PM

Pineal Tumors

http://emedicine.medscape.com/article/249945-overview

54. Finelli DA, Shurin SB, Bardenstein DS. Trilateral retinoblastoma: two variations. AJNR Am J Neuroradiol. Jan 1995;16(1):166-70. [Medline]. 55. Fleege MA, Miller GM, Fletcher GP, et al. Benign glial cysts of the pineal gland: unusual imaging characteristics with histologic correlation. AJNR Am J Neuroradiol. Jan 1994;15(1):161-6. [Medline]. 56. Fvre-Montange M, Champier J, Szathmari A, Wierinckx A, Mottolese C, Guyotat J, et al. Microarray analysis reveals differential gene expression patterns in tumors of the pineal region. J Neuropathol Exp Neurol. Jul 2006;65(7):675-84. [Medline]. 57. Fvre-Montange M, Hasselblatt M, Figarella-Branger D, Chauveinc L, Champier J, Saint-Pierre G, et al. Prognosis and histopathologic features in papillary tumors of the pineal region: a retrospective multicenter study of 31 cases. J Neuropathol Exp Neurol. Oct 2006;65(10):1004-11. [Medline]. 58. Griffin BR, Griffin TW, Tong DY, et al. Pineal region tumors: results of radiation therapy and indications for elective spinal irradiation. Int J Radiat Oncol Biol Phys. May 1981;7(5):605-8. [Medline]. 59. Gururangan S, McLaughlin C, Quinn J, Rich J, Reardon D, Halperin EC, et al. High-dose chemotherapy with autologous stem-cell rescue in children and adults with newly diagnosed pineoblastomas. J Clin Oncol. Jun 1 2003;21(11):2187-91. [Medline]. 60. Haase J, Nielsen K. Value of tumor markers in the treatment of endodermal sinus tumors and choriocarcinomas in the pineal region. Neurosurgery. Oct 1979;5(4):485-8. [Medline]. 61. Herrmann HD, Westphal M, Winkler K, et al. Treatment of nongerminomatous germ-cell tumors of the pineal region. Neurosurgery. Mar 1994;34(3):524-9; discussion 529. [Medline]. 62. Inoue HK, Naganuma H, Ono N. Pathobiology of intracranial germ-cell tumors: immunochemical, immunohistochemical, and electron microscopic investigations. J Neurooncol. 1987;5(2):105-15. [Medline]. 63. Jakacki RI, Zeltzer PM, Boyett JM, et al. Survival and prognostic factors following radiation and/or chemotherapy for primitive neuroectodermal tumors of the pineal region in infants and children: a report of the Childrens Cancer Group. J Clin Oncol. Jun 1995;13(6):1377-83. [Medline]. 64. Jennings MT, Gelman R, Hochberg F. Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg. Aug 1985;63(2):155-67. [Medline]. 65. Jooma R, Kendall BE. Diagnosis and management of pineal tumors. J Neurosurg. May 1983;58(5):654-65. [Medline]. 66. Jouvet A, Fevre-Montange M, Besanon R, et al. Structural and ultrastructural characteristics of human pineal gland, and pineal parenchymal tumors. Acta Neuropathol. 1994;88(4):334-48. [Medline]. 67. Kang JK, Jeun SS, Hong YK, et al. Experience with pineal region tumors. Childs Nerv Syst. Jan-Feb 1998;14(1-2):63-8. [Medline]. 68. Klein P, Rubinstein LJ. Benign symptomatic glial cysts of the pineal gland: a report of seven cases and review of the literature. J Neurol Neurosurg Psychiatry. Aug 1989;52(8):991-5. [Medline]. [Full Text]. 69. Konovalov AN, Pitskhelauri DI. Principles of treatment of the pineal region tumors. Surg Neurol. Apr 2003;59(4):250-68. [Medline]. 70. Krabbe KH. The pineal gland, especially in relation to the problem on its supposed significance in sexual development. Endocrinology. 1923;7:379-414. 71. Linstadt D, Wara WM, Edwards MS, et al. Radiotherapy of primary intracranial germinomas: the case against routine craniospinal irradiation. Int J Radiat Oncol Biol Phys. Aug 1988;15(2):291-7. [Medline]. 72. Malogolowkin MH, Mahour GH, Krailo M, et al. Germ cell tumors in infancy and childhood: a 45-year experience. Pediatr Pathol. 1990;10(1-2):231-41. [Medline]. 73. Matsutani M, Sano K, Takakura K, et al. Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg. Mar 1997;86(3):446-55. [Medline]. 74. Min KW, Scheithauer BW, Bauserman SC. Pineal parenchymal tumors: an ultrastructural study with prognostic implications. Ultrastruct Pathol. Jan-Apr 1994;18(1-2):69-85. [Medline].

6 trong 8

11/14/2011 8:55 PM

Pineal Tumors

http://emedicine.medscape.com/article/249945-overview

75. Mller-Forell W, Schroth G, Egan PJ. MR imaging in tumors of the pineal region. Neuroradiology. 1988;30(3):224-31. [Medline]. 76. Neuwelt EA, Glasberg M, Frenkel E, et al. Malignant pineal region tumors. A clinico-pathological study. J Neurosurg. Nov 1979;51(5):597-607. [Medline]. 77. Olsen MM, Raffensperger JG, Gonzalez-Crussi F, et al. Endodermal sinus tumor: a clinical and pathological correlation. J Pediatr Surg. Dec 1982;17(6):832-40. [Medline]. 78. Ono N, Isobe I, Uki J, et al. Recurrence of primary intracranial germinomas after complete response with radiotherapy: recurrence patterns and therapy. Neurosurgery. Oct 1994;35(4):615-20; discussion 620-1. [Medline]. 79. Packer RJ, Sutton LN, Rorke LB, et al. Intracranial embryonal cell carcinoma. Cancer. Aug 1 1984;54(3):520-4. [Medline]. 80. Packer RJ, Sutton LN, Rosenstock JG, et al. Pineal region tumors of childhood. Pediatrics. Jul 1984;74(1):97-102. [Medline]. 81. Parwani AV, Baisden BL, Erozan YS, et al. Pineal gland lesions: a cytopathologic study of 20 specimens. Cancer. Apr 25 2005;105(2):80-6. [Medline]. 82. Posner M, Horrax G. Eye signs in pineal tumors. Journal of Neurosurgery. 1946;3:15-24. 83. Quest DO, Kleriga E. Microsurgical anatomy of the pineal region. Neurosurgery. Apr 1980;6(4):385-90. [Medline]. 84. Robertson PL, DaRosso RC, Allen JC. Improved prognosis of intracranial non-germinoma germ cell tumors with multimodality therapy. J Neurooncol. Mar 1997;32(1):71-80. [Medline]. 85. Robinson S, Cohen AR. The role of neuroendoscopy in the treatment of pineal region tumors. Surg Neurol. Oct 1997;48(4):360-5; discussion 365-7. [Medline]. 86. Salzman KL, Rojiani AM, Buatti J, et al. Primary intracranial germ cell tumors: clinicopathologic review of 32 cases. Pediatr Pathol Lab Med. Sep-Oct 1997;17(5):713-27. [Medline]. 87. Schild SE, Scheithauer BW, Schomberg PJ, et al. Pineal parenchymal tumors. Clinical, pathologic, and therapeutic aspects. Cancer. Aug 1 1993;72(3):870-80. [Medline]. 88. Shinoda J, Miwa Y, Sakai N, et al. Immunohistochemical study of placental alkaline phosphatase in primary intracranial germ-cell tumors. J Neurosurg. Nov 1985;63(5):733-9. [Medline]. 89. Silvani A, Eoli M, Salmaggi A, Lamperti E, Fariselli L, Milanesi I, et al. Combined chemotherapy and radiotherapy for intracranial germinomas in adult patients: a single-institution study. J Neurooncol. Feb 2005;71(3):271-6. [Medline]. 90. Smirniotopoulos JG, Rushing EJ, Mena H. Pineal region masses: differential diagnosis. Radiographics. May 1992;12(3):577-96. [Medline]. 91. Stein BM. The infratentorial supracerebellar approach to pineal lesions. J Neurosurg. Aug 1971;35(2):197-202. [Medline]. 92. Steinbok P, Dolman CL, Kaan K. Pineocytomas presenting as subarachnoid hemorrhage. Report of two cases. J Neurosurg. Nov 1977;47(5):776-80. [Medline]. 93. Steno J, Bizik I, Biksadsky P. Pineal region teratomas in children. Ann N Y Acad Sci. Sep 17 1997;824:241-4. [Medline]. 94. Takakura K. Intracranial germ cell tumors. Clin Neurosurg. 1985;32:429-44. [Medline]. 95. Talerman A. Germ cell tumours. Ann Pathol. 1985;5(3):145-57. [Medline]. 96. Ueki K, Tanaka R. Treatments and prognoses of pineal tumors--experience of 110 cases. Neurol Med Chir (Tokyo). Jan 1980;20(1):1-26. [Medline]. 97. Villano JL, Propp JM, Porter KR, Stewart AK, Valyi-Nagy T, Li X, et al. Malignant pineal germ-cell tumors: an

7 trong 8

11/14/2011 8:55 PM

Pineal Tumors

http://emedicine.medscape.com/article/249945-overview

analysis of cases from three tumor registries. Neuro Oncol. Apr 2008;10(2):121-30. [Medline]. [Full Text]. 98. Wilson ER, Takei Y, Bikoff WT, et al. Abdominal metastases of primary intracranial yolk sac tumors through ventriculoperitoneal shunts: report of three cases. Neurosurgery. Sep 1979;5(3):356-64. [Medline]. 99. Wolden SL, Wara WM, Larson DA, et al. Radiation therapy for primary intracranial germ-cell tumors. Int J Radiat Oncol Biol Phys. Jul 15 1995;32(4):943-9. [Medline]. 100. Yamashita J, Handa H. Diagnosis and treatment of pineal tumours. Kyoto University experience (1941-1984). Acta Neurochir Suppl (Wien). 1988;42:137-41. [Medline]. 101. Yamini B, Refai D, Rubin CM, Frim DM. Initial endoscopic management of pineal region tumors and associated hydrocephalus: clinical series and literature review. J Neurosurg. May 2004;100(5 Suppl Pediatrics):437-41. [Medline]. 102. Yoshida J, Sugita K, Kobayashi T, et al. Prognosis of intracranial germ cell tumours: effectiveness of chemotherapy with cisplatin and etoposide (CDDP and VP-16). Acta Neurochir (Wien). 1993;120(3-4):111-7. [Medline]. 103. Zondek H, Kaatz A, Unger H. Precocious puberty and choriepithelioma of the pineal gland with report of a case. Journal of Endocrinology. 10:12-16. 104. Zulch KJ. Reflections on the surgery of the pineal gland (a glimpse into the past). Gleanings from medical history. Neurosurg Rev. 1981;4(3):159-63. [Medline]. 105. Echevarra ME, Fangusaro J, Goldman S. Pediatric central nervous system germ cell tumors: a review. Oncologist. Jun 2008;13(6):690-9. [Medline]. 106. Sato K, Takeuchi H, Kubota T. Pathology of intracranial germ cell tumors. Prog Neurol Surg. 2009;23:59-75. [Medline]. 107. Matsutani M. Pineal germ cell tumors. Prog Neurol Surg. 2009;23:76-85. [Medline]. 108. Aoyama H. Radiation therapy for intracranial germ cell tumors. Prog Neurol Surg. 2009;23:96-105. [Medline]. 109. Radovanovic I, Dizdarevic K, de Tribolet N, Masic T, Muminagic S. Pineal region tumors--neurosurgical review. Med Arh. 2009;63(3):171-3. [Medline]. Medscape Reference 2011 WebMD, LLC

8 trong 8

11/14/2011 8:55 PM