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Pineal Tumor

Questions to Ask Your Doctor Before a Biopsy

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

Brain cancer symptoms include headache, weakness, seizures, clumsiness, and difficulty walking A biopsy is a sample of tissue removed by your doctor to make a precise diagnosis. Biopsy procedures can range from a simple sampling of skin under local anesthesia to surgical opening of the chest wall to remove a portion of lung tissue. Biopsies may also be obtained during diagnostic procedures such as endoscopy, colonoscopy, bronchoscopy, and others. Sometimes doctors perform biopsies using a CAT scan or other radiological imaging techniques to help identify the exact area to be sampled and avoid injury to surrounding organs. There are several types of biopsies.

Excisional biopsy. If your doctor finds an area of interest or a suspicious finding (for example, an enlarged nevus, or mole), often an excisional biopsy is performed to remove the area in question in its entirety during the biopsy.

Incisional biopsy. An incisional biopsy refers to removal of only a portion of the area of interest (for example, sampling of a small fragment of tissue from a larger breast lump).

Fine needle biopsy. A fine needle biopsy is used to remove cells or fluid by suctioning through a long, thin needle.

Core needle biopsy. During a core needle biopsy, the doctor inserts a special needle through a skin incision that removes a very thin, cylindrical piece of tissue.

The following questions can help guide your discussions with your doctor concerning a biopsy (print these and take them with you to your doctor's visit):

Read the rest of questions to ask your doctor about biopsy »

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Pineal Tumor Overview

Pineal tumors arise in the region of the pineal gland. This gland is a small structure deep within the brain. These tumors represent about 1% of all brain tumors but account for 3% to 8% of the intracranial tumors that occur in children. At least 17 different types of tumors may occur in this region, and many are benign.

The three most common types of pineal region tumors are:

gliomas,
germ cell tumors, and
pineal cell tumors.

Pineal Tumor Causes

As with most brain tumors, the cause of pineal tumors is largely unknown. Research is underway to discover the possible causes.

Pineal Tumor Symptoms

Pineal region tumors arise in or near the pineal gland, which is a small midline structure located deep in the midbrain area, near many vital structures. The pineal gland is located next to the aqueduct of Sylvius, which serves as a passage allowing cerebrospinal fluid (CSF) to leave the center of the brain where it is first produced. Pineal tumors often compress this aqueduct, causing a build up of pressure of CSF in the brain (called hydrocephalus). Blockage of the flow of this fluid can cause some of the common presenting symptoms of these tumors, which include:

headache,
nausea and vomiting,
seizures,
memory disturbances, and
visual changes.

The intracranial pressure may even increase to life-threatening levels, demanding urgent treatment.

Hydrocephalus can be treated by placement of a ventriculo-peritoneal shunt (VP shunt). The VP shunt is a long tube placed within one of the CSF-containing spaces of the brain, then passed under the skin to the abdominal cavity to provide a pathway for CSF drainage and absorption in the abdomen.

Alternatively, the hydrocephalus can be controlled by a procedure known as a stereotactic third ventriculostomy. Third ventriculostomy creates a tiny opening in the bottom of the brain using a small endoscope to allow the CSF to escape. This procedure is usually performed under local anesthesia (without the need for general anesthesia).

Pineal region tumors may also cause visual changes as a result of involvement of the nearby tectal region which has a primary role in controlling eye movements. These changes may include:

inability to focus on objects,
double vision, and
impairment of eye movements.

These problems may improve or resolve with treatment of the tumor. Certain germ cell tumors may secrete hormones which cause endocrinologic disturbances, such as early onset of puberty in children.