T1 pre-gad T1 post-gad T1 post-gad

Diagnosis: Pineal mass

At surgery, this lesion was noted to be a yellow pineal region mass which appeared encapsulated at the superior aspect. A small segment of the inferior portion was removed and sent to pathology while the remainder of the lesion went up the sucker. Pathologic examination of the specimen showed a pineal cyst; however it is almost certain that this is a neoplasm based on the imaging characteristics. Pineal cysts have been studied at length and although some may be associated with peripheral or nodular enhancement they do not enhance solidly as in this case. In addition, pineal cysts rarely become symptomatic while neoplasms often do. Symptoms of pineal region neoplasms include hydrocephalus from obstruction of the sylvian aqueduct, headache, and Parinaud syndrome. This syndrome is secondary to compression of the dorsal midbrain which contains the periaqueductal gray matter. It is characterized by paralysis of upward gaze, loss of accommodation and pupillary fixation.

Neoplastic lesions of the pineal gland to consider in this age group include pineocytoma, astrocytoma, and metastasis all which may have cystic components. In this case the patient is being treated as though she has a pineal neoplasm and will receive follow-up. The increased T2 signal and the decreased T1 signal in the periventricular white matter adjacent to the anterior horns of the lateral ventricles is due to the transependymal spread of CSF from the hydrocephalus. Related Cases

Sekiya T, Suzuki S, Iwabuchi T. Pineal cyst: its diagnosis and treatment. No Shinkei Geka, Aug 1994; 22(8):p715-21.

Fetell MR, Bruce JN, Burke AM, et al. Non-neoplastic pineal cysts. Neurology, Jul 1991; 41(7):p1034-40.

Fleege MA, Miller GM, Fletcher GP, et al. Benign glial cysts of the pineal gland: unusual imaging characteristics with histologic correlation. AJNR, Jan 1994; 15(1):p161-6.

Inoue Y, Saiwai S, Miyamoto T, et al. Enhanced high-resolution sagittal MRI of normal pineal glands. J Comput Assist Tomogr, Mar-Apr 1994; 18(2):p182-6.

Tien RD, Barkovich AJ, Edwards MS. MR imaging of pineal tumors. AJR, Jul 1990; 155(1):p143-51.















































Colloid cyst Teratoma Pineal cyst