PMC8044440_01
Pre-operative CT scan of the brain. (A-C) Non-contrast CT imaging demonstrating a heterogeneous mass with cystic features and calcification in pineal region causing obstructive hydrocephalus.
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Computed tomography of the head demonstrated a hyperdense, partially cystic pineal region lesion with areas of calcification with supratentorial ventricular dilatation ( Figure 1 ).
Pre-operative MRI of the brain. (A-C) Post-contrast T1-weighted images demonstrating a heterogeneously enhancing 3.9 x 2.6 x 3.1 cm mixed cystic and solid pineal mass and consequential obstructive hydrocephalus. (D, E) T2-weighted images revealed a hyperintense cystic lesion and hypointense solid lesion with mass effect and compression of the cerebral aqueduct resulting in supratentorial ventricular dilatation and periventricular white matter signal abnormality. (F) FLAIR image demonstrated periventricular transependymal flow of cerebrospinal fluid indicative of acute hydrocephalus.
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Magnetic resonance imaging of the brain revealed a heterogeneously enhancing 3.9 x 2.6 x 3.1 cm mixed cystic and solid pineal mass extending into the posterior third ventricle and associated obstructive hydrocephalus ( Figure 2 ).
Post-operative MRI of the brain 12 months following surgery. (A-C) Post-contrast T1-weighted images demonstrating no evidence of residual or recurrent disease. (D, E) T2-weighted images showing resolution of the ventricular dilatation and flow voids from the internal cerebral veins. (F) FLAIR image showing minimal hyperintense signal surrounding the surgical resection cavity.
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Repeat MRI brain at 6-months and 1-year revealed no evidence of residual or recurrent disease ( Figure 3 ).
Histopathological analysis of the resected pineal lesion. (A) Hematoxylin and eosin (H&E) stain with nested architecture and sheets of cells (original magnification, 40x). (B) H&E stain with sheets of cells with speckled chromatin and indistinct to small nucleoli with multifocal necrosis (original magnification, 200x). (C) H&E stain with mitotic figure (original magnification, 400x). (D) Strong immunostaining of tumor cells with synaptophysin (original magnification, 100x).
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Histopathology was consistent with metastatic atypical carcinoid tumor of pulmonary origin ( Figure 4 ).
Histopathological analysis of the primary atypical bronchopulmonary carcinoid tumor. (A) Hematoxylin and eosin (H&E) stain with nested architecture and sheets of cells (original magnification, 40x). (B) H&E stain with sheets of cells with speckled chromatin and indistinct to small nucleoli (original magnification, 200x).
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Comparatively, tumor morphology of the intracranial metastasis was identical to that of the known atypical bronchopulmonary carcinoid lesion diagnosed 2 years prior ( Figure 5 ).