Tumors of the pineal region can occur either in the pineal gland itself or in its surrounding structures, such as the posterior third ventricle, parietal cap, corpus callosum pressure, choroid plexus, and curtain notch. Histopathology is divided into germ cell tumors, parenchymal cell tumors, tumors of supporting structures, and mixed cell tumors. Germ cell tumors are subdivided into germ cell tumors and non-germ cell tumor germ cell tumors. Germ cell tumors are the most common and are extremely sensitive to radiotherapy. 50% of pure germ cell tumors may contain giant syncytial trophoblast cells that produce beta 1 human chorionic gonadotropin. Mature differentiated teratomas are benign, while immature teratomas with embryonic components are malignant. Embryonal carcinomas, endothelial sinus tumors, yolk sac tumors, and choriocarcinomas are differentiated from extraembryonic components of germ cells and are highly malignant. Pineal parenchymal cell tumor is the second most common tumor of the pineal gland, affecting 2/3 of males. This tumor can be subdivided into adult pineal cell tumor and pineal cell tumor. Adult pineal cell tumors are highly malignant, most often in children, and often metastasize along the CSF pathway. Pineal cell tumors, which can occur at any age, can be divided into undifferentiated pineal cell tumors or pineal cell tumors with astrocytic differentiation, which are highly malignant and often metastasize along the CSF pathway, and pineal cell tumors with neurogenic or mixed differentiation, which are benign. Clinical presentation: Almost all patients develop hydrocephalus and intracranial hypertension due to obstruction of the SCF pathway. Parinaud’s syndrome occurs when the tumor compresses and invades the parietal lid, and in males it can cause precocious puberty. Germ cell tumors often metastasize to the hypothalamus and may be associated with diabetes mellitus. Lateral and anterior invasion of the tumor may result in symptoms of hypothalamus, internal capsule and basal ganglia.