Pineal + Suprasellar Lesions



Pineal + Suprasellar Lesions


Karen L. Salzman, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Germinoma


Less Common



  • Lymphoma, Primary CNS


  • Metastases, Intracranial, Other


Rare but Important



  • Germ Cell Neoplasms, Malignant NOS


  • Retinoblastoma (Quadrilateral)


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Age may be a helpful differentiating feature


  • Diabetes insipidus is a common presenting feature of infundibular masses


  • Parinaud syndrome is a common presentation of pineal masses


Helpful Clues for Common Diagnoses



  • Germinoma



    • Most common germ cell tumor


    • Hug midline near 3rd ventricle: 80-90%


    • Pineal region: 50-65%; suprasellar: 25-35%


    • Pineal + suprasellar ˜ 10%


    • Hyperdense masses on CT


    • Homogeneous enhancement


    • CSF seeding common


Helpful Clues for Less Common Diagnoses



  • Lymphoma, Primary CNS



    • Homogeneous enhancing mass(es) along ependymal surface typical


    • May involve sellar & pineal regions


  • Metastases, Intracranial, Other



    • Enhancing masses at gray-white junctions


    • May involve pineal & suprasellar regions


    • Primary tumor often known


Helpful Clues for Rare Diagnoses



  • Germ Cell Neoplasms, Malignant NOS



    • Uncommon, highly malignant tumors: Choriocarcinoma, endodermal sinus tumor, embryonal cell carcinoma, mixed germ cell tumor


    • Heterogeneously enhancing masses


    • Imaging cannot reliably differentiate


    • Characteristic elevation of serum tumor markers



      • Choriocarcinoma: β-hCG; endodermal sinus tumor: AFP; embryonal cell carcinoma: β-hCG & AFP


  • Retinoblastoma (Quadrilateral)



    • Bilateral calcified ocular tumors + midline neuroblastic tumors (pineal & suprasellar)


    • 40% are familial & account for nearly all bilateral & multilateral disease


    • Trilateral disease rare: 5-15% of familial lesions (80% pineal, 20% suprasellar)


    • Quadrilateral disease extremely rare


    • Dismal prognosis, < 24 month survival


Alternative Differential Approaches

Tags:
Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Pineal + Suprasellar Lesions

Full access? Get Clinical Tree
Get Clinical Tree app for offline access