Germinoma of the central nervous system
Headache and visual disturbance. The patient had previous VP shunt placement for obstructive hydrocephalus.
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A well circumscribed lobulated space occupying lesion occupys the pineal region and compressing the tectum anteriorly with obstruction of the acqueduct of sylvius. The mass displays hyperintense signal in non contrast T1 WI, hyperintense signal in T2 and FLAIR images with central area of calcification returns low signal in all pulse sequences (engulfed pineal gland). It also exhibits strong homogenous enhancement after IV contrast. cystic areas are seen within. VP shunt is well placed.