title: Spontaneous Regression of Pineal Lesions: Ghost Tumor or Pineal Apoplexy?
abstract: BACKGROUND
  Pineal apoplexy (either hemorrhagic or ischemic) may complicate the course of a tumor at this site. This event usually is characterized by an acute clinical onset and requires emergency surgical management whereas the regression of the lesion is a much rarer outcome.
  
  
  METHODS
  Three cases of pineal vanishing tumors in the pediatric population are reported and the pertinent literature is reviewed.
  
  
  RESULTS
  In one case, radiologic findings were consistent with a diagnosis of pineal cyst, which became symptomatic after a spontaneous hemorrhage. This event may also explain its regression after the treatment of associated hydrocephalus. In the remaining 2 cases, neuroimaging examinations disclosed a solid tumor. One of them regressed after a surgical biopsy, probably because of an ischemic evolution, whereas the last one disappeared without any medical or surgical manipulation. Neither hemorrhage nor ischemia were noticed, thus the mechanism of regression remains controversial.
  
  
  CONCLUSIONS
  Vanishing tumors of the pineal region may occur in different circumstances, resulting from absence of any medical and surgical action to minor manipulation of the tumor to obtain a biopsy. This variety may reflect different underlying mechanisms, leading to hemorrhagic or ischemic change of the tumor and its subsequent regression, although radiological imaging may fail to document hemorrhage or ischemia.
authors.affiliation: Institute of Neurosurgery-Catholic School of Medicine, Rome, Italy. Electronic address: pierpaolo.mattogno@gmail.com.
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Mattogno
authors.affiliation: Institute of Neurosurgery-Catholic School of Medicine, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Frassanito
authors.affiliation: Institute of Neurosurgery-Catholic School of Medicine, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Massimi
authors.affiliation: Institute of Neurosurgery-Catholic School of Medicine, Rome, Italy.
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Tamburrini
authors.affiliation: Institute of Pathology-Catholic School of Medicine, Rome, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Novello
authors.affiliation: Institute of Pathology-Catholic School of Medicine, Rome, Italy.
authors.forename: Libero
authors.initials: L
authors.lastname: Lauriola
authors.affiliation: Institute of Neurosurgery-Catholic School of Medicine, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Caldarelli
mesh_terms: D000293:Adolescent; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis*; D001932:Brain Neoplasms / Q000150:complications* / Q000175:diagnosis*; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods; D010870:Pineal Gland / Q000000981:diagnostic imaging* / Q000473:pathology*; D012075:Remission, Spontaneous; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Ghost tumor; Pineal apoplexy; Pineal cyst; Pineal gland; Pineal gland degeneration; Vanishing tumor