Multimedia
 | Media file 1: 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). |
 | Media file 2: 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. |
 | Media file 3: 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. |
 | Media file 4: MRI of a 21-year-old man with a germinoma in the pineal region. This T2-weighted noncontrast axial scan shows the tumor as hyperintense to brain matter but hypointense to cerebrospinal fluid (CSF). |
 | Media file 5: MRI of a 21-year-old man with a germinoma in the pineal region. Homogenous gadolinium enhancement of the tumor is demonstrated on this T1-weighted contrast-enhancing sagittal scan. |
 | Media file 6: Sagittal MRI of a heterogeneous mixed germ cell tumor of the pineal region in a 21-year-old man who presented with hydrocephalus. After pathologic examination following complete surgical resection, the tumor was found to have multiple components, including endodermal sinus tumor, embryonal cell carcinoma, immature teratoma, and mature teratoma. |
 | Media file 7: Gross tissue specimens were obtained from a 21-year-old man who presented with hydrocephalus. After pathologic examination following complete surgical resection, the tumor was found to have multiple components, including endodermal sinus tumor, embryonal cell carcinoma, immature teratoma, and mature teratoma (see Image 6). Gross tissue specimens reflect heterogeneity of various germ cell components. |
 | Media file 8: T1-weighted contrast-enhancing sagittal MRI from a 41-year-old man with a pineocytoma. The tumor enhances homogeneously with gadolinium, except for a cystic portion. |
 | Media file 9: Micrograph from a mature teratoma of the pineal region that consists of well-differentiated tissue from all 3 germinal layers. This image demonstrates nonkeratinizing squamous cell epithelium alternating with areas of ciliated columnar epithelium (see Images 11-12). |
 | Media file 10: This micrograph demonstrates osteoid bone with surrounding periosteal tissue and mesenchymal stroma occurring within a mature teratoma of the pineal region (see Image 10 and Image 12). |
 | Media file 11: This micrograph features cartilaginous tissue observed within a mature teratoma of the pineal region (see Images 10-11). |
 | Media file 12: Immature teratoma of the pineal region with highly cellular primitive elements resembling fetal neural tube structure. |
 | Media file 13: Endodermal sinus tumor with a characteristic Schiller-Duval body. |
 | Media file 14: Pineoblastoma composed of highly cellular, poorly differentiated cells that form patternless sheets. |
 | Media file 15: Pineocytoma consisting of benign well-differentiated cells forming rosettes. |
 | Media file 16: MRI of a 44-year-old woman 10 years after resection of a mixed pineal cell tumor. The tumor has recurred in the pineal region (arrow) and has seeded the fourth ventricle (arrowheads). |
 | Media file 17: The right side of this image demonstrates 3 operative approaches to the pineal region. The appropriate patient positioning for each approach is on the left. Number 1 is the supracerebellar-infratentorial approach, number 2 is the occipital-transtentorial approach, and number 3 is the parietal-interhemispheric approach. |
 | Media file 18: The left drawing is a sagittal view of a patient with a pineal region tumor. The right drawing shows a sagittal view of the supracerebellar/infratentorial approach to the pineal region. |
More on Pineal Tumors |
| Overview: Pineal Tumors |
| Workup: Pineal Tumors |
| Treatment: Pineal Tumors |
| Follow-up: Pineal Tumors |
 Multimedia: Pineal Tumors |
| References |
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Further Reading
Keywords
pineal, tumors, pineal tumor, pineal tumors, pineal gland, pineal gland tumors, pineal gland tumor, pineal region tumors, pineoblastomas, pineocytomas, pineal germ cell tumors, germinomas, pineal gliomas, pineal metastasis, obstructive hydrocephalus, vertical gaze palsy, astrocytomas, meningiomas, teratomas, pineal cyst, pineal cysts
