Pineal Tumor

A pineal tumor is a tumor of the pineal gland in your brain. This gland secretes a substance called melatonin that affects your sleep-wake cycles. These are very rare tumors. They happen most often to children and adults younger than 40.  

Pineal tumors can be one or a mix of several different types. They can also be slow growing or fast growing. The World Health Organization (WHO) has a grading system for brain tumors. They are grouped by grade I, II, III, or IV. Grade I is the slowest growing. Grade IV is the most aggressive. Tumors of the pineal gland may be one of these types: 

• Pineocytoma, which are slow-growing (grade I or II). These tumors usually appear between ages 35 and 40, but they can happen to a person at any age. People with pineocytomas tend to have a good outcome.  
• Pineal parenchymal tumor, which are intermediate-grade (grade II or III). Pineal parenchymal tumors and papillary pineal tumors may happen at any age. 
• Papillary pineal tumor, which are intermediate-grade (grade II or III). 
• Pineoblastoma, which are aggressive and fast-growing (grade IV). These tumors most often affect young people under 20 years of age.  
• Mixed pineal tumor, which are a combination of slow- and fast-growing cell types 

Pineal tumors may press against other parts of the brain. They may also block the normal flow of CSF. This increases intracranial pressure (ICP).

The cause of pineal tumors is unknown. Your genetics and your environment may play a role. In some cases, exposure to radiation or gene defects may increase the risk.

Fast growing tumors may cause worse symptoms. When a pineal tumor blocks the flow of CSF, it may cause headaches, nausea, and vomiting. Some of the common signs and symptoms of a pineal tumor may include: 

• Headaches (common) 
• Nausea and vomiting 
• Vision changes 
• Trouble with eye movements 
• Tiredness 
• Trouble walking 
• Balance or coordination problems 
• Tremor

Your doctor will review your personal and family medical history. He or she will also ask about recent symptoms. You will have a physical exam, including a neurologic exam. Your doctor may test your reflexes and ask you to do simple things like touch your finger to your nose. Your doctor may shine a light in your eye to look for swelling of the optic nerve. This may be a sign of increased intracranial pressure. 

If a doctor thinks you have a brain tumor, he or she will want to see images of your brain. You may need tests, such as: 

• MRI. MRIs use radio waves, magnets, and a computer to make detailed images of the brain and spinal cord. For this test, you lie still on a table as it passes through a tube-like scanner. If you are not comfortable in small spaces, you may be given a sedative before the test. 
• Biopsy. In a biopsy, a sample of the tumor tissue is removed and examined for type and grade.  
• Exam of the CSF for tumor cells and other substances. 
• Blood tests to measure levels of substances such as melatonin, and alpha-fetoprotein. 

You may first see your primary doctor. He or she may then refer you to a doctor that specializes in brain problems. This may be a neurologist, neurosurgeon, or neuro-oncologist. Your doctor can help you understand your pathology report. The report tells the size, location, type, grade, and other information about your tumor.

The treatment for your pineal tumor may depend on the size, location, type, and grade of your tumor. Surgery is often needed to remove a pineal tumor. You may also need radiation therapy or chemotherapy. You can work with your medical team to have the best treatment plan for you. You may need a tube to drain excess cerebrospinal fluid, which will lower your intracranial pressure. 

Your treatment will likely depend on your situation. For example, not everyone with a pineal tumor has radiation therapy. Doctors may advise radiation f the tumor has spread within the nervous system. 

Pineal tumors may be hard to remove with surgery because they are so deeply and centrally located in the brain. In some cases, doctors use computer-aided guidance to precisely focus high-powered radiation on the exact area of the tumor. 

You will likely need to have regular follow-up MRI scans to watch for recurrence.

• A pineal tumor is a rare tumor of your pineal gland in your brain. The pineal gland makes melatonin, a substance that regulates your sleep-wake cycle.  
• Pineal tumors can happen at any age, but they tend to happen in children and young adults. 
• The cause is unknown. 
• Pineal tumors can be slow-growing or fast-growing. 
• These tumors may cause problems by pressing against other parts of the brain. 
• Pineal tumors may block the normal flow of CSF, causing increased ICP. 
• You may need surgery, radiation, and chemotherapy for a pineal tumor. 
• Many people with a pineal tumor have a good outcome.

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.