The authors' attitudes toward the diagnosis and treatment of pineal tumors have been dramatically changed in recent years by several important factors: (1) Histological classification has been well established by introduction of the concept of germ cell tumors including germinomas and a variety of teratomas. (2) The value of radiotherapy for germinomas has been firmly established. (3) Operative procedures have been refined by introduction of microsurgical techniques. (4) Preoperative diagnosis has been made easier and more accurate by development of CT and better techniques of cerebrospinal fluid (CSF) cytology, and by the discovery of tumor cell markers such as alphafetoprotein (AFP) and human chorionic gonadotrophin (HCG).
One hundred and thirty-four cases of pineal tumors were experienced in the Department over a period of 38 years from 1941 through 1979, which corresponded to 4.9% of all intracranial tumors treated in the same period. There were 82 cases of germinomas (28 histologically verified and 54 histologically non-verified), 23 teratomas, seven pineoblastomas and 22 others. Among the 82 germinoma cases, there were 71 males and 11 females, with a marked male preponderance. A male preponderance was also found for teratomas. It is well known that germinomas are extremely radiosensitive and some of them are radiocurable. The 5-year survival rate of 35 cases of pineal germinomas treated by radiotherapy was 73% and the 10-year survival was 60%, as compared to 9.0% and 5.0%, respectively, in 22 cases of pineal germinomas without radiotherapy. In the cases of teratomas, however, radiotherapy was not effective and the general prognosis was poorer than in germinomas. Surgery is still the treatment of choice in teratomas and occasionally, long-term survival was obtained after total removal of well differentiated teratomas.