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Neuroimaging diagnosis of pineal region tumors—quest for pathognomonic finding of germinoma

  • Diagnostic Neuroradiology
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Abstract

Introduction

Our study aimed to elucidate the imaging features for the differentiation of pineal germinoma and other pineal region tumors.

Methods

Image data sets of computed tomographic (CT) scan and magnetic resonance imaging (MRI) data of 93 pineal region tumors including 33 germinomas, 30 nongerminomatous germ cell tumors (NGGCTs), 20 pineal parenchymal tumors (PPTs), and 10 miscellaneous tumors of pineal region were reviewed. Imaging features on CT and MRI were qualitatively assessed by three readers. To know the reasons for morphological differences between germinomas and NGGCTs, histological investigation was done.

Results

Localized calcification was seen in more than 70 % of germ cells tumors (GCTs: germinomas and NGGCTs) while it was scattered in more than half of PPTs. Cystic components in tumors were most frequent in NGGCTs (62 %). Multiplicity of lesion was restricted to GCTs: 39.4 % in germinoma and 10.0 % in NGGCTs. Thick peritumoral edema was more frequent in germinoma than in NGGCT: 40.6 vs. 14.8 % (p = 0.0433, Fisher’s test). Bithalamic extension of tumor was seen in 78.8 % of germinomas. It was significantly rare in other groups of tumors (p < 0.0001, Fisher’s test). The relative collagen amount per unit area was significantly lower in germinoma than in NGGCTs.

Conclusion

By paying attention to characteristic features as bithalamic extension, thick peritumoral edema, calcification pattern, multiplicity, and their combination, the preoperative differential diagnosis of pineal germinoma will become more accurate.

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Ethical standards and patient consent

We declare that all human and animal studies have been approved by the Ethics Committee on Epidemiological Studies of Kagoshima University Graduate School of Medical and Dental Sciences (reference no. 24-266) and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that patient consent was waived in this retrospective study.

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan

    Ryuji Awa, Francia Campos, Kazunori Arita, Prasanna Karki, Hiroshi Tokimura, Ryosuke Hanaya, Tatsuki Oyoshi & Hirofumi Hirano

  2. Department of Clinical Oncology & Neuro-oncology Program, Hiroshima University, Hiroshima, Japan

    Kazuhiko Sugiyama

  3. Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Atsushi Tominaga, Kaoru Kurisu & Fumiyuki Yamasaki

  4. Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan

    Yoshihiko Fukukura

  5. Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan

    Yukihiko Fujii

Authors
  1. Ryuji Awa
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  2. Francia Campos
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  3. Kazunori Arita
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  6. Kaoru Kurisu
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  13. Tatsuki Oyoshi
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  14. Hirofumi Hirano
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Corresponding author

Correspondence to Hirofumi Hirano.

Additional information

Ryuji Awa and Francia Campos contributed equally to this work.

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Awa, R., Campos, F., Arita, K. et al. Neuroimaging diagnosis of pineal region tumors—quest for pathognomonic finding of germinoma. Neuroradiology 56, 525–534 (2014). https://doi.org/10.1007/s00234-014-1369-4

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  • DOI: https://doi.org/10.1007/s00234-014-1369-4

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