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Pineal germinoma

Case contributed by Dr Roberto Schubert

Presentation:

Headaches, nausea, vomiting.

Patient Data:

Age: 25
Gender: Male
Race: Middle eastern
Modality: CT

Mass lesion of the pineal region with hyperdense appearance on native scans and intense enhancement. Hydrocephalus with "pressure caps" resulting from aquaeduct obstruction.

Modality: MRI

MRI shows a hypervascular, invasive lesion with perifocal oedema and infiltration of the thalamus and superior tectal plate.

Case Discussion:

Germinoma accounts for more than 50% of neoplasms in the pineal region. It is also known as dysgerminoma or extragonadal seminoma, as opposed to non-seminomatous germ cell tumours (NSGCTs). The latter are more resistant to radiation therapy and require higher doses.

The patient also has a non-enhancing lesion in the right petrous apex, probably a congenital cholesteatoma.

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