Presentation
Headache, diplopia, and ataxia. No prior medical or surgical history.
Patient Data
Mixed attenuation mass in the pineal region extending to the third ventricle with peripheral foci of calcification. It appears to involve the origin of the aqueduct and effaces the right tectal plate.
Associated dilatation of the lateral and third ventricles consistent with obstructive hydrocephalus.
Fourth ventricle is normal in size. Minor sulcal effacement superiorly with loss of the extra-axial spaces in keeping with raised intracranial pressure.
No midline shift or cerebellar tonsillar herniation.
Irregular cystic and solid mass in the pineal region and quadrigeminal plate extending into the third ventricle. It measures maximally 2.5 cm.
The solid component enhances postcontrast and demonstrates restricted diffusion. The mass also demonstrates some rim enhancement. Associated calcifications are better demonstrated on recent CT although are partially seen with susceptibility artifact on gradient-echo imaging.
There is concomitant moderate obstructive hydrocephalus with dilatation of the lateral and third ventricles.
Minor FLAIR hyperintensity along the superior aspect of the lateral ventricles suggests mild transependymal edema.
Partial effacement of the suprasellar cistern, mass effect on the superior aspect of the cerebellum and slightly low-lying cerebellar tonsils. No significant effacement of the fourth ventricle.
The remainder of the brain parenchyma is unremarkable.
There is expected signal void in the major intracranial vessels indicative of their patency.
Case Discussion
Differential for this posterior fossa intracranial lesion included:
- pineal tumor e.g. pineal germinoma, pineoblastoma, astrocytoma, pineocytoma, pineal gland metastases
- quadrigeminal plate tumor e.g. glioma
- medulloblastoma
See more: pineal region mass, pineal parenchymal tumors
Scattered peripherally dispersed calcifications favor pineoblastoma.
Patient underwent resection and pineoblastoma was histopathologically confirmed.