Pineal teratoma

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Synonyms and keywords: Pineal teratomas; Pineal teratoblastoma; Pineal teratoid tumor; Pineal germ cell tumors; Pineal gland tumors; Brain tumor

Overview

  • Pineal teratoma is an uncommon extra-axial intracranial cancer, which can have a bewildering variety of components and thus a wide range of appearances.[1]
  • Pineal teratoma may be classified into three subtypes: mature, immature, and mature with malignant transformation.
  • Mature teratomas are benign, mature, well-differentiated cystic lesions; whereas immature teratomas are poorly differentiated lesions with solid components and malignant transformation.[2]
  • On other occasions, mature teratomas contain elements that undergo malignant transformation (most commonly squamous components).
  • Fat
  • Cystic spaces due to mucous production or other exocrine products
  • Soft-tissue from any part of the body
  • Calcification, including teeth
  • Head CT scan and brain MRI may be helpful in the diagnosis of pineal teratoma.[6] Given their extremely variable histological components, CT/MRI imaging also tends to be heterogeneous, with tumors typically demonstrating a mixture of tissue densities and signal intensity. Fat, if present, is helpful in narrowing the differential.
  • On head CT scan, pineal teratoma is characterized bya mass with fat and calcification, which is usually solid / "clump-like". It usually has cystic and solid components, contributing to an irregular outline. Solid components demonstrate variable enhancement on contrast administration.[6]
  • On brain MRI, pineal teratoma is characterized by:[6]
MRI component Findings

T1

  • Hyperintense components due to fat and proteinaceous/lipid-rich fluid
  • Intermediate components of soft tissue
  • Hypointense components due to calcification and blood products

T1 with contrast

  • Solid soft tissue components show enhancement

T2

  • Mixed signal from differing components
  • The mainstay of therapy for immature pineal teratoma is radiotherapy and/or chemotherapy. The residual or mature component is removed surgically.[7]

References

  1. Intracranial teratomas. Dr Alexandra Stanislavsky and Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/intracranial-teratoma. Accessed on December 10, 2015
  2. Teratoma. Dr Jeremy Jones and Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/teratoma. Accessed on December 10, 2015
  3. 3.0 3.1 Pathology of extra-axial intracranial teratoma. Dr Alexandra Stanislavsky and Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/intracranial-teratoma. Accessed on December 10, 2015
  4. Differential diagnosis of extra-axial intracranial teratomas. Dr Alexandra Stanislavsky and Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/intracranial-teratoma. Accessed on December 10, 2015
  5. 5.0 5.1 Clinical presentation of extra-axial intracranial teratoma. Dr Alexandra Stanislavsky and Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/intracranial-teratoma. Accessed on December 10, 2015
  6. 6.0 6.1 6.2 Radiographic features of intracranial teratoma. Dr Alexandra Stanislavsky and Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/intracranial-teratoma. Accessed on December 10, 2015
  7. Friedman JA, Lynch JJ, Buckner JC, Scheithauer BW, Raffel C (2001). "Management of malignant pineal germ cell tumors with residual mature teratoma". Neurosurgery. 48 (3): 518–22, discussion 522-3. PMID 11270541.


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