Pineal germinoma

Case contributed by Dr Roberto Schubert

Presentation

Headaches, nausea, vomiting.

Patient Data

Age: 25 years
Gender: Male
CT

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

MRI

MRI shows a hypervascular, invasive lesion with perifocal edema 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 tumors (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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