Pineoblastoma

Overview

Pineoblastoma is a type of cancer that starts in the brain's pineal gland. The pineal gland is located in the center of the brain. The gland produces a hormone called melatonin. Melatonin plays a role in the body's natural sleep-wake cycle.

Pineoblastoma begins as a growth of cells in the pineal gland. The cells grow quickly and can invade and destroy healthy body tissue.

Pineoblastoma can occur at any age. But it happens most often in young children. Pineoblastoma may cause headaches, sleepiness and changes in the way the eyes move.

Pineoblastoma can be very difficult to treat. It can spread within the brain and into the fluid around the brain. This fluid is called cerebrospinal fluid. Pineoblastoma almost never spreads beyond the central nervous system. Treatment usually involves surgery to remove as much of the cancer as possible. Additional treatments also may be recommended.

Diagnosis

Tests and procedures used to diagnose pineoblastoma include:

• Imaging tests. Imaging tests can find the location and size of the brain tumor. Magnetic resonance imaging (MRI) is often used to diagnose brain tumors. Advanced techniques also may be used. These could include perfusion MRI and magnetic resonance spectroscopy.

  Additional tests might include computerized tomography (CT) and positron emission tomography (PET) scans.

• Removing a sample of tissue for testing. A biopsy is a procedure to remove a sample of tissue for testing. It can be done with a needle before surgery. Or the sample can be removed during surgery. The tissue sample is analyzed in a lab. This helps determine the types of cells and how quickly they are growing.
• Removing cerebrospinal fluid for testing. A lumbar puncture is a procedure to remove a sample of the fluid around the brain and spinal cord. This procedure is also called a spinal tap. The health care provider inserts a needle between two bones in the lower spine. The needle is used to take cerebrospinal fluid from around the spinal cord. The fluid is tested to look for pineoblastoma cells. Cerebrospinal fluid may also be collected during a biopsy to remove tissue from the brain.

Treatment

Pineoblastoma treatment options include:

• Surgery to relieve fluid buildup in the brain. A pineoblastoma may be big enough to block the flow of cerebrospinal fluid. This puts pressure on the brain. An operation can redirect the fluid through a drain or tube. This helps relieve the pressure. This procedure may be done at the same time as a biopsy or surgery to remove the pineoblastoma.
• Surgery to remove the pineoblastoma. A brain surgeon, also called a neurosurgeon, works to remove as much of the pineoblastoma as possible. Sometimes all of the cancer can't be removed. This is because pineoblastoma forms near important structures deep inside the brain. More treatments after surgery are usually needed. These treatments target the remaining cells.

• Radiation therapy. Radiation therapy uses high-energy beams to kill cancer cells. These beams can come from X-rays, protons or other sources. During radiation therapy, a machine directs beams to the brain and spinal cord. Extra radiation is directed at the cancer cells.

  Radiation is often given to the entire brain and spinal cord. This is because the cancer cells can spread from the brain to other parts of the central nervous system. This treatment is often recommended for adults and children older than 3.

• Chemotherapy. Chemotherapy uses strong medicine to kill cancer cells. Chemotherapy is usually used after surgery or radiation therapy. Sometimes it's used at the same time as radiation therapy. For larger pineoblastomas, chemotherapy may be used before surgery. This might shrink the cancer and make it easier to remove.
• Radiosurgery. Stereotactic radiosurgery focuses multiple beams of radiation on exact points to kill cancer cells. Radiosurgery is sometimes used to treat pineoblastoma that comes back after treatment.
• Clinical trials. Clinical trials are studies of new treatments. These studies offer a chance to try the latest treatment options. Side effects from these treatments may not be known. Ask your child's health care provider whether your child might be able to participate in a clinical trial.