PMC6243328_01
A non-contrast CT scan of the head demonstrates a heterogeneous mass in the pineal gland, resulting in obstructive hydrocephalus of the third and lateral ventricles.
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Non-enhanced CT imaging showed an approximately 2.2 cm heterogeneous mass without calcification in the pineal gland region (Figure 1).
MRI of the brain with and without contrast demonstrates a mildly lobulated, well-circumscribed, T1 hypo/isointense (a), T2 hyperintense (b) soft tissue mass with enhancement (c) in the pineal region. A small non-enhancing component is seen in the anterior aspect of the tumour.
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Fluid attenuation inversion recovery images demonstrated the mass to be hyperintense (Figure 2). There was compression of the tectal plate and obstructive hydrocephalus with transependymal cerebrospinal fluid flow (Figure 2).
Diffusion weighted images (a) and apparent diffusion coefficient map (b) show an apparent diffusion coefficient value of 1077.01 x 10-6 mm2 s-1 +- 191.14 mm2 s-1.
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The ADC value of the tumour was 1077.01 x 10-6 mm2 s-1  +- 191.14 mm2 s-1 (Figure 3), which is higher than the normal brain tissue value.
Low power magnification shows a moderately cellular tumour forming sheets and pseudo-rosette patterns with absence of well-formed rosettes (a). High power magnification shows relatively uniform cells with weakly eosinophilic cytoplasm, round nuclei and granular chromatin (b).
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Immunohistochemical staining showed diffuse positivity for neuron-specific enolase and focal positivity for neurofilament and synaptophysin (Figure 4).