Case contributed by A.Prof Frank Gaillard

Patient Data

Gender: Male

CT brain

A 14 X 13 (axial) mm soft tissue density mass in the pineal region with eccentric peripheral calcification demonstrated. The ventricles are prominent, out of keeping with the degree of sulcal prominence, indicating mild to moderate obstructive hydrocephalus due to the lesion partially obstructing the upper margin of the cerebral aqueduct. Periventricular hypoattenuation is in keeping with chronic small vessel ischaemia +/- transependymal CSF accumulation. No other significant intracranial abnormality. 


MRI brain

Circular mass centered in pineal region measures 12 x 11 x 9 mm and demonstrates homogeneous enhancement (on volumetric sequence for stereotaxis), peripheral calcification and diffusion restriction.  It has mass effect on the adjacent structures with stenosis of the cerebral aqueduct (some flow still present on cine imaging) and associated non-communicating hydrocephalus affecting the lateral ventricles and 3rd ventricle. Periventricular FLAIR hyperintensity may represent some transependymal oedema superimposed on chronic small vessel disease.  

Foramina of Monroe are patent. No other suspicious enhancing lesion, including of the leptomeninges. No suprasellar/sellar mass in non-dedicated study.



The sections show a moderately cellular tumour. It often forms rosettes and nests, surrounded by vascularised stroma. The tumour cells have generally round nuclei, granular chromatin, small nucleoli and moderate amounts of eosinophilic cytoplasm. No nuclear moulding is seen. Occasional cells show degenerate nuclear changes with moderate nuclear enlargement and smudged chromatin pattern. No mitoses are seen. There is no endothelial cell hyperplasia or necrosis. The tumour cells are diffusely positive for synaptophysin and neurofilament. The  Ki-67 index is 2-3%. 

FINAL DIAGNOSIS: pineocytoma (WHO Grade I).

Case Discussion

Typical appearances of a small pineocytoma. 

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Case information

rID: 22767
Published: 21st Apr 2013
Last edited: 20th Mar 2018
Inclusion in quiz mode: Included

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