What are the other Names for this Condition? (Also known as/Synonyms)

• Cyst of the Pineal Gland
• Pineal Cyst

What is Pineal Gland Cyst? (Definition/Background Information)

• Pineal Gland Cyst is a type of cystic lesion occurring within the pineal gland in the brain. It is mostly benign and is commonly seen among the general population, especially among young adult women
• The pineal gland is a small endocrine gland located below the cerebrum, at the center of the brain, behind the brainstem. The gland secretes melatonin that helps regulate sleep patterns and the internal body clock
• The cause and risk factors for Pineal Gland Cyst are unknown. It is proposed that in women the tumor develops due to certain hormonal changes, since a large percentage of the cases are diagnosed in them
• Small-sized Pineal Gland Cysts do not present any significant signs and symptoms; and these form the majority. However, large tumors that obstruct the cerebral aqueduct may cause increased intracranial pressure with associated headaches, nausea, vomiting, and seizures
• Many individuals with Pineal Gland Cyst may not require any treatment. However, a surgery may be considered in case of severe symptoms, as determine by the healthcare provider. The prognosis is typically excellent for individuals diagnosed with Pineal Cysts

Who gets Pineal Gland Cyst? (Age and Sex Distribution)

• Pineal Gland Cyst is frequently observed among the adult population; it is reported that between 2-5% of the adults may have this cyst
• Pineal Cysts are found in individuals of all age groups; although, the peak incidence is between ages 20 to 30 years
• Both males and females are affected, but a female predominance is observed (3:1 female-male ratio)
• Individuals of all racial and ethnic background may be affected

What are the Risk Factors for Pineal Gland Cyst? (Predisposing Factors)

• Currently, no risk factors have been identified for Pineal Gland Cyst
• Gender: Over 75% of such cysts are noted in women; thus, women have a much higher risk than men for Pineal Cysts

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Pineal Gland Cyst? (Etiology)

• The cause of development of Pineal Gland Cyst is unknown
• However, since a majority of these lesions are observed in women, it is suspected that hormonal factors influence the formation of the cysts

What are the Signs and Symptoms of Pineal Gland Cyst?

The signs and symptoms of Pineal Gland Cyst can vary from one individual to another and depends on the size of the cystic tumor. In general, most small tumors are asymptomatic and no significant symptoms are observed, while large tumors are known to present symptoms. In many individuals, tumors that grow slowly and remain asymptomatic, may be diagnosed during certain radiological imaging studies of the head and neck region, which are performed for unrelated health conditions.

Most Pineal Cysts are 1 cm or smaller in size (average of 5 mm) and are asymptomatic; some are between 1 to 3 cm in size. Generally, in men, once the cyst grows and develops, it achieves a stable size with no further increase in its dimension. In women, an initial increase in size is noted, followed by a subsequent shrinkage over time.

Significant signs and symptoms usually occur from large-sized cysts causing compression of the aqueduct of Sylvius, a duct through which the cerebrospinal fluid flows, resulting in increased intracranial pressure and hydrocephalus.

The signs and symptoms may include:

• Persistent headaches
• Nausea and vomiting
• Increased intracranial pressure may be observed if there is obstruction of the cerebrospinal fluid (CSF) drainage, since the ventricular system is affected. This may result in nausea, vomiting, headaches, and seizures
• Obstruction of the CSF also leads to increased size of the head and associated complications, a condition termed as obstructive hydrocephalus
• Parinaud’s syndrome. It is characterized by limited upward gaze (upgaze paresis), irregular eye movements, poor control of pupil, and lid retraction affecting both eyes
• Loss of muscle control or ataxia
• Dizziness and vertigo

How is Pineal Gland Cyst Diagnosed?

A majority of cystic brain tumors may remain undiagnosed for prolonged periods, if they are asymptomatic and generally slow-growing. The slow development of symptoms may contribute to a delayed detection and diagnosis of these cysts. They may be detected when there is a sudden worsening of symptoms prompting the healthcare provider to perform radiological studies of the brain.

Pineal Gland Cysts are often incidental findings on investigation studies performed for other neurological conditions. They may also be misdiagnosed as a pineocytoma on imaging scans.

The diagnosis of Pineal Gland Cyst may involve the following tests and examinations:

• Complete physical examination and a thorough medical history
• Assessment of the presenting signs and symptoms
• Neurological, motor skills, and cognitive assessment:
  • Checking intellectual ability, memory, mental health and function, language skills, judgment and reasoning, coordination and balance, reflexes, and sensory perceptions (space, sight, hearing, touch, etc.)
  • The healthcare provider/neurologist may use the Karnofsky Performance Scale in order to assess the neurological functioning of the individual’s central nervous system (CNS)
• Electroencephalography (EEG)
• Electromyography with nerve conductivity tests
• Imaging studies that may be performed include:
  • X-ray of head and neck region
  • Computerized tomography (CT) scan of the head and neck region; CT with contrast
  • Magnetic resonance imaging (MRI) scan of the central nervous system (brain and spine); MRI with contrast agents such as gadolinium
  • Cerebral angiographic studies or MR angiography: An angiogram involves injecting dye into the bloodstream, which makes the blood vessels to appear visually on X-rays. The X-ray may show a tumor in the brain or the blood vessels leading into the tumor
  • Magnetic resonance spectroscopy: This radiological technique is used to study the chemical profile of the tumor. It is often performed with and compared to corresponding MRI scan images of the affected region
• Cerebrospinal fluid analysis, where a spinal tap or lumbar puncture procedure may be performed: This diagnostic test is used to remove a sample of cerebrospinal fluid (CSF) from the spaces in and around the brain and spinal cord. The sample is removed from the lower spinal cord using a thin needle, and it is then checked for the presence of cancer cells
• Molecular studies, if necessary

Tissue biopsy: A biopsy of the affected region (brain) is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy sample under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy sample under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis.

A differential diagnosis to eliminate other conditions or tumor types may be considered, before arriving at a definitive diagnosis.

The radiological differential diagnosis may include:

• Arachnoid cyst
• Choriocarcinoma
• Embryonal carcinoma
• Epidermoid cyst of brain
• Germinoma
• Metastasis to the brain
• Papillary tumor of the pineal region
• Pineal parenchymal tumor with intermediate differentiation
• Pineocytoma
• Teratoma of brain
• Vein of Galen aneurysm

The pathological differential diagnosis may include:

• Pilocytic astrocytoma
• Pineocytoma
• Other cranial cysts

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Pineal Gland Cyst?

The complications of Pineal Gland Cyst may include the following:

• Stress and anxiety due to fear of a brain tumor
• Large tumor masses may get secondarily infected with bacteria or fungus
• Very rarely, pineal apoplexy develops, which is a sudden worsening of the neurological conditions due to hemorrhage in pineal space, typically into a Pineal Cyst increasing its size
• Recurrence of the tumor following its incomplete surgical removal
• Damage to the muscles, vital nerves, and blood vessels, during surgery
• Post-surgical infection at the wound site is a potential complication

How is Pineal Gland Cyst Treated?

The treatment of Pineal Gland Cyst may involve the following:

• In a great majority of cases of small-sized tumors, the healthcare provider may consider conservative ‘wait and watch’ measures, instead of recommending surgery to remove them
• Generally, a complete surgical excision may be infrequently undertaken for large and progressively growing cystic tumors
  • The surgeon may use certain microsurgical approaches, such as an endoscopic brain surgery, to drain cyst contents and/or remove the cyst
  • Surgery to remove Pineal Cysts offer a lot of challenges to healthcare providers, due to the considerable complexity of the pineal region
• Follow-up care with regular screening and check-ups are important and encouraged

How can Pineal Gland Cyst be Prevented?

Currently, there are no known methods available to prevent the occurrence of a Pineal Gland Cyst.

What is the Prognosis of Pineal Gland Cyst? (Outcomes/Resolutions)

• In a vast majority of individuals, the prognosis for Pineal Gland Cyst is excellent, even in the absence of any treatment, since it is typically benign and small-sized
• Large tumors may require suitable treatment in the form of surgery. In such cases, the overall prognosis depends on the initial set of symptoms and post-operative complications noted, if any

Additional and Relevant Useful Information for Pineal Gland Cyst:

The following article link will help you understand other cancers and benign tumors:

http://www.dovemed.com/diseases-conditions/cancer/