Case contributed by Dr Hani Al Salam


Increasing headache and visual symptoms.

Patient Data:

Age: 30 years
Gender: Male

CT brain

Modality: CT

A large lobulated mass is centered on the pineal gland, engulfing the pineal calcifiation. It is somewhat hyperdense compared to adjacent brain. A further smaller mass is seen in the floor of the third ventricle. The midbrain is distorted, compressed and demonstrates low density suggestive of oedema. Obstructive hydrocephalus is present. 

MRI brain

Modality: MRI

An EVD has been placed and the size of the ventricles has reduced. A subdural collection has developed, which is blood stained. The masses seen on CT are more easily seen on MRI. They are heterogeneous with prominent variegated enhancement, and a moderate amount of oedema extending into the adjacent parenchyma, particularly the brain stem. 

On gradient echo imaging the pineal calcification is confirmed to be placed centrally within the mass (engulfed). 

This patient went on tho have a craniotomy and a biopsy of the pineal region mass confirming the diagnosis of a germinoma. 

Case Discussion:

This case illustrates fairly typical appearances of a germinoma with involvement of both the pineal region and the floor of the third ventricle / suprasellar region. 

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