Presentation
Headache and altered gaze.
Patient Data
A large well defined mass with restricted diffusion, but limited contrast enhancement centered in the pineal region. It results in obstructive hydrocephalus, clearly of some duration (as the ventricles are very large) but also with transependymal edema.
Sagittal FLAIR sequence just off midline. The mass is clearly demonstrated wtihin the posterior portion of the third ventricle (red line). The pineal can be seen separate from the mass.
The patient went to theater for excision of the mass.
Histology confirmed the mass to be an ependymoma.
Case Discussion
This is a case of a common pediatric tumor being found in an uncommon location. In pediatric populations, ependymomas are usually found in the posterior fossa. And, they are not usually amongst the differential of a pineal region mass.
However, the mass does abut the posterior portion of the third ventricle and it is its location within the 3rd ventricle and its subsequent expansion of the ventricle and obstruction of the aqueduct that should aid diagnosis.