Pineal germinoma

Case contributed by Jude Gregan
Diagnosis certain



Patient Data

Age: 20 years
Gender: Male

MRI brain


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

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

CT brain


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




Paraffin sections show multiple small fragments of a densely hypercellular tumor. 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.


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