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Pineal germinoma

Case contributed by Angel Donato
Diagnosis almost certain

Presentation

1 month history of headache accompanied by vomiting. The b-HCG in the cerebrospinal fluid was 87.95 mIU/ml, carcinoembryonic antigen (CEA) and alpha-fetoprotein (Alpha-FP) were negative. The serum levels of b-HCG was 19.52 mIU/ml.

Patient Data

Age: 20 years
Gender: Female
mri

There is a large pineal region mass with moderate enhancement with compression of the tectum resulting in obstructive hydrocephalus.
On SWAN imaging the pineal calcification is confirmed to be placed centrally. On T2 the pineal mass is hyperintense. Diffusion-weighted imaging (DWI) shows restriction with low apparent diffusion coefficient (ADC) values.

Case Discussion

The masses of the pineal gland can be found incidentally in MRI in 1.4-10% of the cases, at autopsy the prevalence can increase up to 40%. The most frequent masses are cysts, followed by tumors and vascular lesions. According to the World Health Organization (WHO), tumors can be divided into germ cell tumors and non-germinomatous tumors including teratomas, embryonal carcinoma, yolk sac tumors, choriocarcinoma, and mixed germ cell tumors. The two most frequent are germinoma in 50-60% of cases and teratoma in 15%.

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