EC Neurology

Pineoblastomas are aggressive tumors of the pineal region, primarily affecting children and adolescents, with frequent craniospinal metastasis. MRI plays a key role in diagnosis, surgical planning, and differentiation from other pineal tumors.

This case report describes a 16-year-old male with headaches, nausea, and vomiting, diagnosed with a WHO grade IV pineoblastoma. Imaging revealed typical features, including hypointensity on T1-weighted MRI and restricted diffusion. Treatment involved surgical resection, followed by adjuvant radiotherapy and chemotherapy.

Pineoblastomas typically present with symptoms of intracranial hypertension due to obstructive hydrocephalus. MRI and CT scans help characterize the tumor, showing hypointensity on T1-weighted images, restricted diffusion, and heterogeneous enhancement following gadolinium injection. The tumor often compresses surrounding brain structures, such as the dorsal midbrain, and shows high cellularity. Pineoblastomas also have a tendency for leptomeningeal spread, necessitating full spinal imaging.

The primary treatment is surgical resection, with adjuvant radiotherapy and chemotherapy. Prognosis improves with complete resection and in patients over 5 years old. The use of high-dose induction chemotherapy and autologous hematopoietic stem cell transplantation may improve outcomes, especially in younger patients.

 Keywords: Pineoblastoma; Pediatrics; Brain MRI; Primitive Neuroectodermal Tumor (PNET); Radiotherapy; Chemotherapy; Surgical Resection

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