9 Masses in the Pineal Region

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig SK 9-1 Germinoma. Enhancing tumor (T) in the pineal region of a young girl with paralysis of upward gaze, headaches, and nausea (Parinaud's syndrome). The minimal dilatation of the third ventricle (arrowheads) and lateral ventricles (arrows) indicates mild hydrocephalus, which developed because of obstruction of the posterior portion of the third ventricle by the tumor.

• Fig SK 9-2 Germinoma. Sagittal T1-weighted MR image shows a large isointense mass (arrowheads) that compresses the midbrain (arrow) and elevates the splenium of the corpus callosum.

• Fig SK 9-3 Teratoma. Nonenhanced scan shows an inhomogeneous mass containing a large amount of calcification.

• Fig SK 9-4 Teratoma. Axial T2-weighted MR image shows a pineal mass that is markedly hypointense because of high fat content and extensive calcification.

• Fig SK 9-5 Embryonal cell carcinoma. (A) Axial T2-weighted MR image shows a tumor with heterogeneous signal intensity in the pineal gland (arrows). (B) Contrast T1-weighted image shows some enhancing foci within the tumor (arrows).20

• Fig SK 9-6 Pineocytoma. Pineal mass that is hypointense (arrowheads) on a sagittal T1-weighted image (A) and hyperintense (arrows) on an axial T2-weighted image (B).

• Fig SK 9-7 Pineoblastoma. Huge densely calcified mass in the pineal region causing obstructive hydrocephalus.

• Fig SK 9-8 Metastasis. In this patient with lung carcinoma, an unenhanced scan shows a well-circumscribed, hyperdense pineal mass (large arrows) containing dense punctate calcification (small arrows). Air in the frontal horns (white arrows) resulted from a recent ventricular shunting procedure. Note the tentorial calcification (open arrow) adjacent to the metastasis.1

• Fig SK 9-9 Meningioma. Densely enhancing mass in the pineal region that arises from the incisura of the tentorium. Note the characteristic flat border (arrows) along the tentorium.

• Fig SK 9-10 Vein of Galen aneurysm. A contrast-enhanced scan shows dilatation of the vein of Galen and straight sinus (open arrows). Note the prominent feeding vessels of the choroid plexus (closed arrows) and the anterior cerebral arteries (thin arrows).

• Fig SK 9-11 Pineal cyst. Round pineal mass (arrows) that is markedly hypointense on a coronal T1-weighted image (A) and hyperintense on an axial T2-weighted image (B).