Given the patient's age, gender and imaging findings, the main differential considerations for this pineal region mass are pineal germ cell tumor (such as germinoma) and a parenchymal tumor (such as pineocytoma), among the other less common entities.

Considerable overlap exists in the imaging appearance of pineal lesions and there are no definitive imaging findings that may distinguish germinoma from a pineal parenchymal tumor.

Following resection, this mass proved to be a pineal germinoma.