Presentation
Headache and visual disturbance. The patient had previous VP shunt placement for obstructive hydrocephalus.
Patient Data
A well-circumscribed lobulated lesion with cystic areas occupies the pineal region, compressing the tectum anteriorly with obstruction of the aqueduct of Sylvius. The mass displays hyperintense signal in non-contrast T1 WI, hyperintense signal on 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. VP shunt is well placed.
Case Discussion
The engulfed calcified pineal gland favors the diagnosis of germ cell tumor. This was confirmed by histopathology to be a germinoma.
Other differential diagnoses of pineal region tumors include pineoblastoma, pineocytoma, meningioma, and astrocytoma.
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