PMC4629301_01
65-year-old male presented with headache and was later diagnosed with pineal gland lymphoma. Axial non-contrast CT of the head demonstrates a homogeneously hyperdense mass (arrow) in the pineal gland region. There are no calcifications or hemorrhage identified.
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F1
CT demonstrated a homogeneous hyperdense mass in the pineal gland region with mild hydrocephalus, but no calcification or hemorrhage [Figure 1]. Contrast MRI was performed, which demonstrated a homogeneously enhancing mass involving the pineal gland, with increased perfusion with corresponding low apparent diffusion coefficient values [Figure 2].
65-year-old male presented with headache and was later diagnosed with pineal gland lymphoma. (a) Axial T1 post-contrast MRI image of the head demonstrates a homogeneously enhancing mass (arrow) in the region of the pineal gland. (b) Axial MRI diffusion-weighted imaging (DWI) sequence demonstrates increased signal (arrow). (c) The corresponding axial apparent diffusion coefficient (ADC) map demonstrates low ADC values (arrow).
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F2
CT demonstrated a homogeneous hyperdense mass in the pineal gland region with mild hydrocephalus, but no calcification or hemorrhage [Figure 1]. Contrast MRI was performed, which demonstrated a homogeneously enhancing mass involving the pineal gland, with increased perfusion with corresponding low apparent diffusion coefficient values [Figure 2].
65-year-old male presented with headache and was later diagnosed with pineal gland lymphoma. (a) Axial T2 FLAIR MR image demonstrates the pineal gland mass (arrow) as isointense to mildly hyperintense to brain parenchyma. (b) Sagittal T1-weighted MR image demonstrates that the mass is hypointense. (c) Sagittal T1 post-contrast MR image again shows the enhancing pineal gland mass (arrowhead) as well as leptomeningeal enhancement near the supraoptic recess (arrow) and cerebellar velum.
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F3
Leptomeningeal enhancement was identified near the supraoptic recess and along the cerebellar velum [Figure 3].
65-year-old male presented with headache and was later diagnosed with pineal gland lymphoma. (a) Hematoxylin and eosin staining at magnification (40x) demonstrates malignant lymphoma with coarse chromatin, nucleoli (arrow), and mitoses. (b) Diaminobenzidene chromagen at magnification (40x) demonstrates tumor cells (arrow) extensively exhibiting CD20 reactivity. (c) Diaminobenzidene chromagen at magnification (40x) demonstrates tumor cells (arrow) exhibiting extensive CD79a, but no neural, myogenic, or epithelial marker immunoreactivity.
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F4
The histopathology showed a hypercellular tumor with high nuclear/cytoplasmic ratio, but no pineocytomatous or Homer Wright rosettes or papillary architecture [Figure 4].