Case contributed by Dr Aneta Kecler-Pietrzyk


30 years old patient with a history of ongoing headache, diplopia and ataxia. No prior medical or surgical history.

Patient Data

Age: 30
Gender: Female

Mixed attenuation mass in the pineal region extending to the third ventricle with peripheral foci of calcification. It appears to involve the origin of the aqueduct and effaces the right tectal plate.

Associated dilatation of the lateral and third ventricles consistent with obstructive hydrocephalus.

Fourth ventricle is normal in size. Minor sulcal effacement superiorly with loss of the extra-axial spaces in keeping with raised intracranial pressure.

No midline shift or cerebellar tonsillar herniation. 


Irregular cystic and solid mass in the pineal region and quadrigeminal plate extending into the third ventricle. It measures maximally 2.5 cm.

The solid component enhances postcontrast and demonstrates restricted diffusion. The mass also demonstrates some rim-enhancement. Associated calcifications are better demonstrated on recent CT although are partially seen with susceptibility artefact on gradient echo imaging.
There is concomitant moderate obstructive hydrocephalus with dilatation of the lateral and third ventricles.

Minor FLAIR hyperintensity along the superior aspect of the lateral ventricles suggests mild transependymal edema.

Partial effacement of the suprasellar cistern, mass effect on the superior aspect of the cerebellum and slightly low-lying cerebellar tonsils. No significant effacement of the fourth ventricle.

The remainder of the brain parenchyma is unremarkable.

There is expected signal void in the major intracranial vessels indicative of their patency.

Case Discussion

Differential for this posterior fossa intracranial lesion included: 

See more: pineal region masspineal parenchymal tumors

Scattered peripherally dispersed calcifications favor pineoblastoma.

Patient underwent resection and pineoblastoma was histopathologically confirmed. 

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Case information

rID: 54572
Published: 19th Aug 2017
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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