Pineal tumors and associated lesions: the effect of ethnicity on tumor type and treatment.

Pineal region lesions consist of a wide variety of rare tumor types, including deep midline cysts, intrinsic pineal tumors, germ cell tumors and vascular lesions. Advances in microsurgical, endoscopic and stereotactic techniques have helped to lower morbidity and mortality in the care of patients harboring these lesions. Surgery can be the definitive treatment in cysts and benign lesions. This report summarizes the retrospective experience of the authors with 64 pineal region and associated lesions encountered in multiple institutions over the last 20 years. Histology was obtained in 53 out of 64 radiographically apparent lesions. Direct surgical biopsy of solid and vascular tumors in the pineal region enables precise histological assessment of mixed tumors. By avoiding sampling error, precise treatment can be planned. This series, along with previously published data, shows a much higher incidence of intrinsic pineal tumors, glial tumors and nongerminomatous germ cell tumors in series from North America and Europe than in those from Japan and Korea, where germinoma is much more common. We experienced an incidence of 20.4% germinoma out of 49 solid and vascular pineal tumors, while other authors have described incidences of 51.2 and 53.5%, respectively. The fact that histology is more diverse in Western populations leads to a need to have more representative sampling. Early surgical resection combined with diversion of cerebrospinal fluid is effective in the treatment of pineal lesions and seems to be superior to the alternative of treatment based on the diagnostic response to radiation and/or on tumor markers alone.