Pineal region mass: meningioma

Case contributed by Dr Henry Knipe

Presentation

Acute onset vertigo. Further characterisation of lesion seen on CT.

Patient Data

Age: 86
Gender: Female
MRI

There is a large pineal region mass, which is isointense to grey matter on T1 and slightly hyperintense on T2. There is a small cystic region in the inferior portion. The mass shows diffusion restriction, and vividly and homogeneously enhances. It has a broad attachment to the inferior margin of the falx cerebri, displacing the internal cerebral veins inferiorly and to the right, with mass effect and thinning of the splenium of the corpus callosum. There is no mass effect on the cerebral aqueduct and no hydrocephalus. A normal pineal gland cannot be identified. Normal enhancement of the straight sinus. This is a solitary lesion.

Case Discussion

Given the patient's age and lack of symptoms (vertigo was felt to be incidental to this mass), histology is not available for confirmation. This mass has all the characteristics of a meningioma, just in an uncommon position. Seeing a normal pineal gland would be further reassuring but this is unlikely to be pineal in origin because it displaces the internal cerebral veins inferiorly, whereas a pineal gland mass would displace the internal cerebral veins superiorly. 

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Case information

rID: 40485
Case created: 23rd Oct 2015
Last edited: 15th Feb 2016
Inclusion in quiz mode: Included

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