Background: With the increasing availability and advances in brain imaging, pineal cyst lesions (PCL) are becoming a common finding in the pediatric population. In the absence of evidence-based guidelines, optimal diagnostic and therapeutic approaches have not been established, and there is a risk of under- or overtreatment of these patients. Objectives: The aim of our study was to evaluate the clinical presentation and radiological features of PCL in a cohort of pediatric patients and to identify clinical parameters more commonly associated with neoplasms in the pineal region. In addition, the prevalence of PCL in the pediatric population of Slovenia was estimated. Methods: In this observational, cohort study, children treated at University Children's Hospital, Ljubljana, Slovenia in the period 1997-2016 were included if PCL was found on brain imaging. We analyzed indications for referral to a neurologist, clinical signs and symptoms, radiological features, treatment and outcome. Results: The cohort consisted of 143 children with PCL. Pineocytoma was suspected in 31 children (21.7%). Six children underwent surgery - pineocytoma was confirmed in two cases and germinoma in one (2/3 of these children had signs of increased intracranial pressure (ICP), while PCL was benign in the remaining 4 cases. Only 2 PCL enlarged during the study period, both <2mm, none of these children developed neoplasm. Two children had PCL >20mm in diameter; both showed signs of increased ICP, one patient was found to have a germinoma of the pineal region, while the other had no neoplasm. Conclusions: Most PCL do not change their features during radiological follow-up and even atypical PCL are very rarely associated with a malignant neoplasm of the pineal region. A PCL larger than 20 mm and signs of increased ICP were identified as potential markers for selecting patients at risk.

中文翻译：

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儿童非良性松果体囊肿病变的临床和放射学特征。

背景：随着脑成像技术的日益普及和进步，松果体囊肿 (PCL) 正在成为儿科人群中的常见发现。由于缺乏循证指南，最佳诊断和治疗方法尚未建立，这些患者存在治疗不足或过度治疗的风险。目的：我们研究的目的是在一组儿科患者中评估 PCL 的临床表现和放射学特征，并确定与松果体区肿瘤更常见的临床参数。此外，估计了斯洛文尼亚儿科人群中 PCL 的患病率。方法：在这项观察性队列研究中，在卢布尔雅那大学儿童医院接受治疗的儿童，如果在脑成像中发现 PCL，则将 1997-2016 年期间的斯洛文尼亚包括在内。我们分析了转诊给神经科医生的指征、临床体征和症状、放射学特征、治疗和结果。结果：该队列由 143 名患有 PCL 的儿童组成。31 名儿童（21.7%）怀疑松果体细胞瘤。6 名儿童接受手术 - 2 例确诊松果体细胞瘤，1 例确诊为生殖细胞瘤（其中 2/3 的儿童有颅内压升高的迹象，而其余 4 例的 PCL 为良性。研究期间只有 2 例 PCL 增大, 均<2mm，这些儿童均未发生肿瘤。两名儿童PCL直径>20mm；均表现出ICP升高的迹象，一名患者发现松果体区的生殖细胞瘤，而另一名患者未发现肿瘤。结论：大多数 PCL 在放射学随访期间不会改变其特征，甚至非典型 PCL 也很少与松果体区的恶性肿瘤相关。大于 20 毫米的 PCL 和 ICP 增加的迹象被确定为选择有风险患者的潜在标志物。