Pineal germinoma

Case contributed by Jude Gregan

Presentation

Headaches.

Patient Data

Age: 20 years
Gender: Male
MRI

MRI brain

Hydrocephalus. Pineal region mass, coarse calcification of the tumour, mild enhancement.

Differential: A germ cell tumour (both germinoma and non-germinoma germ cell tumour, the latter particularly in view of coarse calcification) is favoured over a pineal parenchymal tumour (e.g. pineoctyoma or pineal parenchymal tumour with intermediate differentiation), 

CT

CT brain

Post-ventriculostomy, CSF accumulating deep to scalp with the third ventriculostomy obstructed by clot or tumour spread. 

Pathology

Histology

MICROSCOPIC DESCRIPTION:

Paraffin sections show multiple small fragments of a densely hypercellular tumour. These are composed of atypical large cells with round and oval vesicular nuclei containing conspicuous amphophilic nucleoli and a narrow rim of pale cytoplasm.  These cells show strong immunostaining for c-kit and patchy weak staining for placental  alkaline phosphatase (PLAP) and CD30 and are admixed with moderate numbers of CD3+ T lymphocytes and lesser numbers of CD20+ B lymphocytes and CD68+ monocyte-macrophages. No staining for GFAP is
seen. The features are of germinoma. The topoisomerase proliferation index is approximately 40%. No normal pineal tissue is identified.


FINAL DIAGNOSIS: Germinoma

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Case information

rID: 48909
Case created: 30th Oct 2016
Last edited: 23rd Mar 2017
Inclusion in quiz mode: Included

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