A.

Diagnosis banding
1. Pineoblastoma
a. Pineacytoma
Pineocytomas adalah tumor parenkim pineal yang relatif jinak yang
memiliki prognosis relatif baik.
Pineocytomas are a relatively benign pineal parenchymal tumour that
have a relatively good prognosis.

Pada pencitraan, mereka umumnya muncul sebagai tumor yang berbatas tegas dengan
kurang dari 3 cm, iso untuk hyperattenuating pada CT, hypo untuk isointense pada
T1, dan hyperintense di T2. Perangkat tambahan avid dan homogen adalah
karakteristik. perubahan kistik mungkin ada, yang dalam beberapa kasus, dapat
membuat sulit diferensiasi dari kista pineal.

On imaging, they generally appear as a well-demarcated tumour with less than 3 cm,
iso to hyperattenuating on CT, hypo to isointense on T1, and hyperintense on T2. An
avid and homogeneous enhancement is characteristic. Cystic changes may be present,
which in some cases, can make difficult the differentiation from a pineal cyst.

CT: CT menunjukkan massa menjadi kepadatan menengah, mirip dengan otak yang
berdekatan. kalsifikasi pineal cenderung tersebar perifer. Ini adalah pola yang sama
terlihat pada tumor pineal parenkim lainnya, yang membantu dalam membedakan
tumor ini dari germinomas pineal yang cenderung 'menelan' kalsifikasi pineal.

CT : CT demonstrates the mass to be of intermediate density, similar to the adjacent

brain. Pineal calcifications tend to be dispersed peripherally. This is the same pattern
seen in other pineal parenchymal tumours, which is helpful in distinguishing these
tumours from pineal germinomas that tend to 'engulf' pineal calcification.

MRI: MRI adalah modalitas pilihan untuk memeriksa tumor wilayah pineal.
T1: hypo ke isointense ke parenkim otak
T2
o komponen padat isointense ke parenkim otak
o daerah perubahan kistik yang umum
o kadang-kadang sebagian dari tumor kistik
T1 C + (Gd): komponen padat jelas meningkatkan

MRI : MRI is the modality of choice for examining tumours of the pineal region.

T1: hypo to isointense to brain parenchyma

T2
 o solid components are isointense to brain parenchyma

o areas of cystic change are common

o sometimes the majority of the tumour is cystic

T1 C+ (Gd): solid components vividly enhance

Potongan T1 C+

Selected images from an MRI demonstrate the pineal gland to be

enlarged and enhancing. No hydrocephalus.

coronal T1 C+
Axial T2

Axial Flair

sagital T1
 axial T1

b. Papillary tumor of the pineal region

tumor papiler wilayah pineal (PTPR) adalah entitas baru-baru dijelaskan hanya
termasuk dalam klasifikasi WHO terbaru, dan meskipun mungkin timbul dari
ependymocytes khusus organ subcommissural terletak di lapisan komisura posterior
dan bukan dari pineal kelenjar itu sendiri ependymocytes dari organ subcommissural
terletak di lapisan komisura posterior daripada dari kelenjar pineal sendiri. Hal ini
juga hipotesis bahwa beberapa atau banyak deskripsi dipublikasikan biasa pineal
wilayah koroid papiloma pleksus dan ependymomas papiler mewakili PTPRs, karena
histologis mereka sulit untuk membedakan, yang membutuhkan imunohistokimia.

Papillary tumour of the pineal region (PTPR) is a recently described

entity only included in the most recent WHO classification 3, and are
though perhaps to arise from specialised ependymocytes of the
subcommissural organ located in the lining of the posterior commissure
rather than from the pineal gland itself ependymocytes of the
subcommissural organ located in the lining of the posterior commissure
rather than from the pineal gland itself 1,2. It is also hypothesised that
some or many published descriptions of unusual pineal region choroid
plexus papillomas and papillary ependymomas represent PTPRs, as
histologically they are difficult to distinguish, requiring
immunohistochemistry 1.

MRI: PTPRs menunjukkan intrinsik sinyal T1 tinggi dikaitkan dengan inklusi

sekretori . Peningkatan Kontras moderat dan daerah kistik umum.
Intrinsik sinyal T1 tinggi adalah temuan yang relatif tertentu ketika
penyebab lain dari T1 shortening dikecualikan (mis lemak dalam teratoma
/ lipoma; melanoma atau hemoragik metastasis; aneurisma thrombosed).
 Skrining seluruh sumbu saraf diperlukan sebagai CSF diseminasi telah
dilaporkan dalam hingga 7% dari kasus.

MRI : PTPRs demonstrate intrinsic high T1 signal attributed to secretory

inclusions 1. Contrast enhancement is moderate and cystic regions
common.
Intrinsic high T1 signal is a relatively specific findings when other causes
of T1 shortening are excluded (e.g fat in teratomas / lipomas; melanoma
or haemorrhagic metastases; thrombosed aneurysms).
Screening of the entire neural axis is required as CSF dissemination has
been reported in up to 7% of cases 4.

c. Pineal cyst
kista pineal yang umum, biasanya tanpa gejala, dan biasanya ditemukan secara
kebetulan. pentingnya mereka terutama dalam kenyataan bahwa mereka tidak dapat
dibedakan dari tumor kistik, terutama ketika besar atau ketika fitur atipikal yang
hadir. Dengan demikian, banyak pasien menjalani berkepanjangan tindak lanjut untuk
lesi ini, mungkin dengan kecemasan terkait.

Mereka umumnya hadir sebagai kista unilocular dalam kelenjar pineal, di mana
pelemahan atau sinyal cairan dapat bervariasi dari mirip dengan CSF sekitar 60%
menjadi sedikit hyperintense untuk CSF pada T1 gambar tertimbang. A tipis, pelek
kelancaran peningkatan kontras terlihat dalam banyak kasus dan kalsifikasi yang
hadir di 25% dari kasus.
Pineal cysts are common, usually asymptomatic, and typically found incidentally.
Their importance is mainly in the fact that they cannot be distinguished from cystic
tumours, especially when large or when atypical features are present. As such, many
patients undergo prolonged follow-up for these lesions, presumably with associated
anxiety.

They generally present as a unilocular cyst within the pineal gland, where attenuation
or fluid signal may vary from similar to CSF to around 60% being slightly
hyperintense to CSF on T1 weighted images. A thin, smooth rim of contrast
enhancement is seen in most cases and calcifications are present in 25% of instances.

CT :Well circumscribed fluid density lesions with thin rim calcification seen in
3
~25% . Thin, smooth peripheral enhancement is also often seen. The internal cerebral
veins are elevated and splayed by the cyst.

MRI

T1

o typically iso to hypointense compared to brain parenchyma

 o 55-60% are somewhat hyperintense when compared to CSF 3

o usually homogenous in signal

T2

o high signal

o usually slightly hypointense to CSF

FLAIR: high signal does not often suppress fully

DWI/ADC: they demonstrate no restricted diffusion

T1 C+ (Gd)

o ~ 60% of lesions enhance

o enhancement is usually thin (<2 mm), smooth and confined to the rim (either
complete or incomplete)

o it is important to note that if postcontrast imaging is delayed (60-90 min),

gadolinium may diffuse into the cyst fluid and may lead to the mass appearing
solid

o in atypical cases enhancement may be nodular, or there may be evidence of

previous haemorrhage into the cysts