Pineal Gland Tumors: Symptoms, Diagnosis, and Treatment

A pineal gland tumor represents an uncommon type of growth located in the area where the pineal gland, a very small part of the brain, exists; or a little ways away from it. If you have received news about a brain lesion, as well as simply learning the term “tumor” in a report regarding your MRI, it may be unsettling. Nonetheless, many people are aware that there is no indication that all findings within the pineal region represent cancer, nor do all cysts and lesions identified by MRI require treatment.

In fact, if a doctor suspects a pineal gland tumor requires serious attention. The pineal gland is positioned closely to areas which manage eye movements and cerebrospinal fluid (fluid surrounding the brain and spinal cord) pathways. Due to its position, a pineal tumor can potentially result in symptoms due to the small size of the tumor.

This guide explains pineal gland tumor symptoms, diagnosis, and treatment in clear terms. It also covers the difference between a pineal cyst and a tumor, what to expect from a pineal gland MRI, and when symptoms may need urgent care.

Important: This article is for general education. It cannot diagnose a brain tumor or explain an individual MRI result. Contact a doctor promptly if you have new or worsening neurological symptoms.

What Is a Pineal Gland Tumor?

The pineal gland is a small endocrine gland near the center of the brain. Its best-known job is making melatonin, a hormone that helps support the body’s sleep-wake rhythm. Learn more in our guide to the pineal gland’s function, location, and melatonin.

A pineal gland tumor is a growth that starts in the pineal gland or in the nearby pineal region. Doctors may use several names, including:

• Pineal tumor
• Pineal region tumor
• Pineal mass
• Pineal lesion

Not all of those words represent the same definition. “Lesion” represents an area which appears abnormal on a diagnostic image. It can be used to describe several abnormalities such as cysts, tumors, inflammation, scarring, etc. Doctors will perform additional tests in order to determine exactly what has occurred with the lesion.

Pineal tumors are very rare. Pineal tumors can occur at any age (childhood/adult) but some types are more commonly found at various ages. Slow-growing pineal tumors tend to be less aggressive than fast-growing pineal tumors. The former require immediate treatment whereas the latter require emergency treatment.

Each type of pineal tumor is significant since the diagnosis dictates what actions will follow. For example, if a patient requires surgery, radiation therapy, chemotherapy or a combination of the three.

For a medical overview of tumors that form in this area, see the National Cancer Institute’s information on pineal region tumors.

Why the Pineal Region Can Cause Symptoms

The pineal gland is small, but it sits in a crowded part of the brain. Nearby structures help control eye movement, alertness, balance, and the normal circulation of cerebrospinal fluid.

A tumor in this space can cause symptoms in two main ways:

1. By pressing on nearby brain structures
2. By blocking the normal flow of cerebrospinal fluid

When fluid cannot flow normally, it may build up in the brain’s fluid-filled spaces. This condition is called hydrocephalus. Hydrocephalus raises pressure inside the skull and can cause symptoms that need prompt medical attention.

Symptoms can also depend on the tumor’s size, growth rate, and exact location. Two people with similar-looking findings on an MRI may have very different experiences.

Pineal Gland Tumor Symptoms

Some initial symptoms from a Pineal gland tumor may seem as though they could be just about anything. Tiredness or headaches are very common and do not always mean you have a pineal tumor.

On the other hand, some neurological symptoms that worsen and include loss of vision, repetitive vomiting, vertigo or dizziness, and mental confusion need to be checked by your doctor.

Headaches

Headaches are some of the most common symptoms associated with tumors that occur on or near the pineal gland. Hydrocephalus can cause pressure within the cranium (the bony covering for your brain) to increase which leads to a headache.

The type of headache caused by increased intracranial pressure may be exacerbated in the mornings, while lying down, or when you strain. However, there is no standard pattern as to how they will develop. In general, most headaches have nothing to do with a brain tumor.

You should see a doctor if you experience new headaches; more severe than usual headaches; worsening frequency of headaches; or headaches accompanied by other neurological symptoms.

Nausea and vomiting

Nausea and vomiting can occur when pressure inside the skull increases. Repeated vomiting without a clear stomach illness deserves medical review, especially when it occurs with headache, vision changes, or unusual sleepiness.

Vision and eye movement changes

The pineal region is close to areas that help coordinate eye movement. A tumor may make it hard to move the eyes upward. This is sometimes part of a group of signs called Parinaud syndrome.

Possible eye-related symptoms include:

• Blurred vision
• Double vision
• Trouble looking upward
• Difficulty focusing
• Eyes that do not move together normally
• Sensitivity to bright light

These symptoms can have many causes. However, sudden or worsening vision changes should never be ignored.

Balance, coordination, and walking problems

Pressure on surrounding parts of the brain can cause difficulty with coordination; therefore some individuals may be unstable, lose coordination, feel dizzy or weak. They could also experience difficulties walking in a straight line, as well as report to doctors that they have lost their normal sense of balance.

Many different things can lead to a loss of balance. These include an issue with the inner ear (vestibular), side effects of medication, lack of fluids (dehydration), migraines, etc. The combination of a new onset of dizziness along with headaches and/or changes in visual perception require immediate evaluation by a doctor.

Changes in alertness, thinking, or behavior

Increased intracranial pressure from hydrocephalus can cause alertness issues. It is common for someone with increased intracranial pressure to report unusual fatigue, confusion, lack of focus, or feeling mentally slowed down. The family members will likely detect these changes before the individual experiencing them recognizes them.

All symptoms that include extreme confusion, severe drowsiness, passing out (fainting), and significant behavioral changes are considered emergency situations.

Sleep changes

There has been speculation about whether sleep disturbances are among the most prevalent symptoms of pineal gland disease. While there have been reports of individuals who have experienced an effect on their sleep due to a tumor located within the pineal gland, it’s rare.

Insomnia, excessive day time fatigue, and abnormal patterns of sleeping are generally unrelated to tumors of the pineal gland. These types of symptoms occur far more frequently as a result of stress, schedules, mental illness, sleep disorders, medications used by the patient to treat his/her condition, caffeinated beverages, etc.. Our article on pineal gland hormones, melatonin, and body rhythms explains the pineal gland’s normal role in sleep timing.

Hormone-related changes in children

In children, some pineal-region tumors may affect hormone signaling. Early puberty can be a possible sign in some situations. Changes in growth, development, thirst, appetite, or behavior should be discussed with a pediatrician.

For a fuller clinical list of possible symptoms, see Mayo Clinic’s pineal gland tumor symptoms guide.

Types of Pineal Tumors

There is no single type of pineal tumor. The pineal region can contain tumors that start from several kinds of cells. A specialist may not know the exact type until imaging, lab tests, and sometimes tissue testing are complete.

Common categories include the following.

Germ cell tumors

The most commonly known tumors that develop within the Pineal Region, especially in children and young people, include germ cell tumors. These abnormal cell formations occurred at an early stage of development.

Germinoma (a specific type of germ cell tumor) as well as other types of germ cell tumors produce substance referred to as tumor markers; these can be measured by doctors in a patient’s blood or cerebrospinal fluid.

Doctors need to correctly diagnose this type of tumor because some have shown positive responses to radiation and/or chemotherapy.

Pineocytoma

Pineocytomas are generally benign tumors which grow slowly in the cells of the pineal gland. Although most do not produce symptoms due to their slow growth rate, if they compress other surrounding tissue structures or obstruct cerebrospinal fluid (CSF) flow, they can still produce symptoms.

Treatment typically involves surgical removal with consideration for additional treatments depending on characteristics of the tumor and the extent to which the tumor was completely excised.

Pineal parenchymal tumor of intermediate differentiation

This long name describes a tumor that falls between slower-growing and more aggressive pineal tumors. Doctors often shorten it to PPTID.

Treatment plans vary. They may include surgery, radiation, and sometimes chemotherapy.

Pineoblastoma

A pineoblastoma is a rare, more aggressive tumor. It occurs more often in children but can affect adults as well. Treatment commonly involves a combination of surgery, radiation therapy, and chemotherapy.

Other tumors near the pineal gland

Not every pineal region tumor begins in the pineal gland itself. Tumors from nearby brain tissue can grow into this area. Rarely, cancer that started elsewhere in the body can spread to this part of the brain.

This is why a careful diagnosis matters. The word “pineal” describes the location, but it does not always reveal the exact tumor type.

How Doctors Diagnose a Pineal Gland Tumor

Diagnosis often takes place in stages. The first goal is to understand the symptoms, identify urgent problems such as hydrocephalus, and examine the finding on brain imaging.

Medical history and neurological exam

A doctor will ask about symptoms, when they began, whether they are worsening, and any personal or family health history. They may also complete a neurological exam.

This exam can check:

• Eye movement and vision
• Reflexes
• Strength and sensation
• Balance and coordination
• Walking pattern
• Memory, speech, and alertness

The results can help show which areas of the nervous system may be affected.

Pineal gland MRI

An MRI of the pineal gland is typically the best way to see what’s going on when there is an abnormality (mass) in the pineal region. The reason is that MRI scans use magnetic fields and radio waves to make images of the different parts of the brain such as the soft tissues.

The doctor will probably put some kind of contrast dye into your body so you can get a better picture of where the dye goes in relation to the tumor or other abnormalities. This can give us ideas about how much blood flow it has and possibly even some idea about its structure.

An MRI report may describe:

• Size and Location of Lesion
• Whether Solid/Cystic/Mixed
• Enhancement Characteristics
• Effect on Surrounding Structures
• Blockage of CSF Flow
• Presence of Hydrocephalus

MRI findings can help doctors narrow down the possibilities, but an MRI alone cannot always identify the exact tumor type.

CT scan

A CT scan may be used in addition to MRI. CT is especially useful for showing calcification and bone detail. It can also be used quickly in emergency settings when a person has severe symptoms.

Calcification in the pineal gland is common and often harmless, especially with age. It is not the same as a tumor. Read more in our guide to pineal gland calcification symptoms and what they mean.

Blood and cerebrospinal fluid tests

Some pineal tumors, especially germ cell tumors, may release tumor markers. Doctors may check blood for substances such as alpha-fetoprotein, often called AFP, and beta-human chorionic gonadotropin, often called beta-hCG.

In some cases, doctors may also test cerebrospinal fluid. This fluid is collected through a lumbar puncture, also called a spinal tap. However, it is not safe for every person. If pressure inside the skull is high, doctors may first address the fluid buildup.

Biopsy and pathology

The goal of a biopsy is to collect enough tissue to study. Specialists look at this tissue with a microscope, or they use additional testing methods to find the cancer.

In many instances, it will be necessary for specialists to perform a tissue diagnosis (the examination of tissue) if imaging studies or blood work does not provide sufficient evidence to confirm a diagnosis of cancer. Sometimes, a biopsy is performed as part of relieving hydrocephalus, either during surgery or via the operating room.

Specialists consider all the possible advantages and disadvantages before deciding whether or not to perform a biopsy. Due to its depth within the brain, a neurosurgical team needs to have experience working on patients with tumors located near the pineal gland prior to planning a surgical intervention.

For more detail on the testing process, review Mayo Clinic’s guide to pineal gland tumor diagnosis and treatment.

Pineal Cyst vs. Tumor: What Is the Difference?

It’s understandable to worry about a tumour if you read in an MRI report that your pineal gland was mentioned, but a pineal cyst and a pineal tumour are two completely different types of discoveries.

A pineal cyst is essentially a fluid-filled pouch (or “cyst”) which is most commonly identified by accident when undergoing an MRI for other reasons. The majority of these are small, non-cancerous, do not produce any type of symptom and therefore require no form of treatment.

However, a pineal tumour is an abnormal growth of cells within the pineal gland. These may also grow as either benign or malignant. Pineal tumours may take the shape of solid tumours, solid with areas of cystic formation, or be part-liquid/partsolid.

The appearance of a simple pineal cyst will typically be round/oval in shape and have a very thin wall. It’s typical characteristics will also mimic those of Cerebro-Spinal Fluid (CSF). Tumours on the other hand will usually show more of a solid mass, irregular shapes, and possibly a combination of both. They will likely demonstrate increased enhancement of the area with contrast agents, and may even invade surrounding tissues.

This is not something you can use to make decisions at home. While many cysts will exhibit some irregularities and while some tumours can also have aspects that resemble cysts; this is why it would be best for a Radiologist and the patient’s Doctor to review all images/symptoms/medical history before making any type of decision regarding whether or not there is a problem.

If your report mentions a cyst, start with our detailed guide on pineal gland cyst symptoms, MRI, and treatment. For a direct side-by-side comparison of how a tumor and a cyst each appear on MRI, see our guide to pineal gland tumor vs. cyst on MRI.

Pineal Gland Tumor Treatment

Pineal gland tumor treatment depends on the exact tumor type, size, grade, location, spread, symptoms, and the person’s age and health. Care is often managed by a team that includes a neurosurgeon, neurologist, neuro-oncologist, radiation oncologist, endocrinologist, and other specialists.

Treating hydrocephalus

If a tumor blocks cerebrospinal fluid flow, relieving pressure may be the first priority.

Doctors may use a procedure called an endoscopic third ventriculostomy. It creates a new pathway for fluid to flow. In other cases, a shunt may be placed to move fluid away from the brain.

Treating hydrocephalus can help relieve headaches, vomiting, drowsiness, and other pressure-related symptoms.

Surgery

Surgery may have several goals:

• Obtain tissue for diagnosis
• Remove part or all of a tumor
• Relieve pressure
• Restore normal fluid flow

Whether full removal is possible depends on the tumor’s location and how close it is to vital brain structures. The safest option is not always complete removal. In some cases, surgeons remove as much as they can safely, then use other treatments for remaining tumor tissue. If surgeons do remove the entire gland, our guide to living without a pineal gland explains what the research shows afterward.

Radiation therapy

Radiation therapy uses focused energy to damage tumor cells. It may be recommended after surgery, when surgery is not possible, or as a main treatment for tumors that respond well to radiation.

The treatment plan depends on the tumor type and age of the patient. Doctors take special care with children because developing brains are more sensitive to radiation effects.

Chemotherapy

Chemotherapy uses medicines to kill or slow the growth of cancer cells. It may be used with radiation therapy, before surgery, after surgery, or when a tumor has spread.

Some germ cell tumors and more aggressive pineal tumors may respond well to chemotherapy. The exact drugs and treatment schedule depend on pathology results.

Clinical trials

Clinical trials study newer treatments or new combinations of current treatments. They may be an option for certain tumor types, especially rare or recurrent tumors.

Ask the care team whether a trial is available and whether it is appropriate for the situation.

Follow-up care

Even after treatment, regular follow-up is important. This may include MRI scans, neurological exams, hormone testing, rehabilitation, and support for sleep, memory, mood, or balance changes.

Follow-up schedules vary. Your medical team will base them on the tumor type and treatment received.

When to Seek Urgent Medical Care

Call emergency services or seek urgent care if you or someone else has:

• A quick-onset or quickly-worsening headache
• Vomiting over and over again along with a headache
• Major changes in your eyesight (double vision), significant loss of vision, serious problem with moving your eyes
• Extreme confusion, fainting, extreme sleepiness, and/or an inability to stay awake
• You are experiencing seizure-like activity
• Quick onset of muscle weakness, you have difficulty speaking or you have significant trouble walking.

The presence of these symptoms does NOT necessarily indicate that there is a tumor on the pineal gland. These symptoms may indicate many other types of acute and potentially life-threatening conditions of the brain. The most prudent course of action is to seek immediate medical care.

Key Takeaways

• A pineal gland tumor is an abnormal growth that occurs in or near the pineal gland in the center of the brain.
• Common symptoms caused by a pineal gland tumor are headaches, nausea and vomiting, visual disturbances such as blurred vision, difficulty moving your eyes up, imbalance (as well as other types of neurological issues), and excessive sleepiness due to blockage of normal blood flow through your brain (hydrocephalus) because of the tumor pressing against surrounding structures.
• These symptoms can be caused by either compression of adjacent areas of the brain, or obstruction of normal cerebrospinal fluid circulation resulting in hydrocephalus.
• The primary method of diagnosing a pineal gland tumor will be with an MRI, however it may be difficult to determine what type of tumor you have based upon imaging alone.
• You may need to undergo blood work, cerebrospinal fluid analysis, and/or a biopsy to confirm the diagnosis.
• Unless you have been told otherwise by a doctor, if you see something unusual on your MRI, consult a specialist who specializes in neuro-radiology.
• Treatment options for pineal gland tumors include surgical removal, treatment for hydrocephalus, radiation therapy, chemotherapy, and close follow-up.

Frequently Asked Questions

Is a pineal gland tumor considered to be cancer?

While some pineal tumors are malignant (cancer), other tumors tend to grow at a slower pace. Evaluation by specialists using medical images (such as MRIs) as well as laboratory studies or sometimes a tissue sample (biopsy) is needed for a definitive identification of the tumor.

Will a pineal cyst ever become a tumor?

Typically, no. Pineal cysts and pineal tumors represent two very distinct entities. While unusual or changing characteristics seen during an MRI could necessitate additional follow-up to confirm the identity of the abnormality, most typically a cyst will remain a cyst.

Can an MRI help identify a pineal cyst versus a pineal tumor?

An MRI can provide your doctor with useful information. Simple cysts usually have thin walls filled with liquid. Tumors tend to be solid; they may also show irregularities or mixtures. An MRI, however, should never be used as the sole means of diagnosing an abnormality on the brain. Even when abnormalities are clearly shown via MRI, it is often impossible to definitively diagnose them based upon this test alone.

Are there warning signs that indicate you might have developed a pineal tumor?

There are several possible warning signs including headaches that do not go away, nausea and/or vomiting, eye problems such as blurred vision or difficulty moving your eyes upward, dizziness/balance issues, excessive daytime sleepiness. Again, all of these symptoms may result from multiple conditions so it is best to consult a healthcare professional.

Does a pineal tumor impact melatonin or sleep?

In rare cases yes, because the pineal gland produces melatonin which controls our circadian rhythms. In almost every case where a person has trouble sleeping the cause of their problem is NOT due to a pineal tumor. The vast majority of sleep disorders have much simpler explanations.

Is a pineal gland tumor treatable?

Yes. Most types of pineal tumors are treatable with various treatment plans depending on what type of tumor you have (i.e., benign vs. malignant), where the tumor is located in your brain, how large the tumor is, and if the tumor has spread to other parts of your body. The treatments may include surgery; radiation; chemotherapy; or a combination of the three mentioned above.

Should I worry if my MRI report mentions pineal calcification?

No. While there are many conditions which could cause calcification within your pineal gland, such as hypercalcemia or metastatic cancer, calcification in the adult pineal gland is a very common incidental finding. In fact, the majority of studies have found that over 80% of people who underwent a CT or MRI scan had calcification present in their pineal gland. Therefore, unless the radiologist specifically states that the findings suggest possible malignancy, most likely a physician will tell you that this is simply an incidental finding and does not require follow-up testing.

Final Thoughts

When learning of potential growths in your pineal gland as a result of your symptoms or your MRI results, it could seem like an overwhelming experience, due to all the unanswered questions.

Keep in mind that pineal tumors occur very infrequently and the majority of pineal gland findings (small cysts and calcification) are non-tumor in nature.

It will likely provide the best assistance for further action by discussing your symptoms or your MRI results with a competent health care provider. The best resource to contact would be either a neurologist, neurosurgeon, or a neuro-oncology group that can help to explain what your findings represent, if additional studies should be ordered, and what treatments might be available for you.

You cannot depend solely upon internet-based resources for determining the cause of a brain-related issue. Seek emergency medical attention immediately if you experience severe headache(s), repeated vomiting, vision loss, confusion, or significant imbalance.

Medical information changes over time. For personal advice or help understanding MRI results, speak with a qualified neurologist, neurosurgeon, or other healthcare professional.

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Sources and Further Reading

The following trusted medical resources provide more detail on pineal gland tumors, symptoms, diagnosis, and treatment options:

1. National Cancer Institute: Pineal Region Tumors
   An overview of rare tumors that develop in the pineal region, including diagnosis and treatment information.
2. Mayo Clinic: Pineal Gland Tumor, Symptoms and Causes
   A clear guide to possible symptoms, causes, and complications associated with pineal gland tumors.
3. Mayo Clinic: Pineal Gland Tumor, Diagnosis and Treatment
   Information about MRI scans, biopsies, surgery, radiation therapy, chemotherapy, and follow-up care.