PMC3512338_01
Computed tomography scan showing a high-density tumor in the pineal region accompanied by obstructive hydrocephalus
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Computed tomography (CT) showed a high-density 35-mm diameter tumor in the pineal region and obstructive hydrocephalus [Figure 1].
Preoperative magnetic resonance imaging. The tumor was heterogeneously hyperintense on T1- (a) and iso- and low-mixed intense on T2-weighted images (b). It contained hemorrhagic components of very low intensity on T2* images (c)
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On T2* images, it contained very low intensity areas suggestive of hemorrhagic components [Figure 2].
Intraoperative photograph (left occipital transtentorial approach) showing a dark red solid tumor in the pineal region
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After the dense arachnoid over the quadrigeminal cistern was opened, a dark red, easily bleeding solid tumor was found in the pineal region [Figure 3].
Photomicrographs of the excised tumor. Hematoxylin and eosin staining showed anaplastic spindled or epithelioid cells arranged in nests, fascicles, or sheets, displaying variable cytoplasmic melanin (a and b, x100). These tumor cells exhibited significant cellular pleomorphism and nuclear atypia. Mitotic figures were seen occasionally (c, x400). The tumor cells were positive for HMB45 (d, x200) and Melan-A (e, x200). The MIB-1 index was 17.4% (f, x200)
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Additionally, the MIB-1 index was 17.4 +- 3.0% [Figure 4].
Whole-body 18-fluoro-deoxyglucose positron emission tomography showing no abnormal uptake
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A whole-body 18-fluoro-deoxyglucose positron emission tomography (FDG-PET) scan showed no abnormally increased uptake [Figure 5].
Magnetic resonance imaging after 56 months of surgery. Axial T1-weighted images (a) and T2-weighted images (b) showing no lesion in the pineal gland
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