Presentation
Recent postoperative status after ventricular shunting and biopsy
Patient Data
A pineal region large (>4cm) poorly defined irregular mass is seen with evidence of invasion into adjacent brain parenchyma namely tectum of midbrain and cerebellum. It is seen eliciting isointense to hypointense signal to the adjacent brain on T1 WI and isointense to high signal on T2 WI with "exploded "calcifications. It is seen showing vivid heterogeneous enhancement in post-contrast series. ADC showed low signal denoting restricted diffusion.
Subsequent supra-tentorial hydrocephalic changes are seen with trans-ependymal CSF permeation. A ventricular shunt tube is seen ending into the right lateral ventricular body.
Multifocal nodular leptomeningeal enhancement is seen along the entire length of cord denoting CSF seeding.
Case Discussion
Pineal region sizable (>4 cm) irregular mass with evidence of invasion into adjacent brain and CSF seeding diagnostic of Pineoblastoma (pathologically proven).
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