G. Hahn (Bereich Kinderradiologie/Uniklinikum Dresden/Deutschland)  

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14 Years  

Female  

Head-Brain and brain nerves  

neoplastic  

14 year old girl with increasing headaches for 1/2 year. Now additionally emesis and ataxia.  

The tumor develops from parenchymal cells of the pineal gland and is highly malignant. (Small, round cells like Medulloblastoma)  

<- view MRI 1

MRI 1: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






<- view MRI 2

MRI 2: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






<- view MRI 3

MRI 3: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






<- view MRI 4

MRI 4: T2-TSE sagital: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas. In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor. The brainstem is shifted towards ventral and the aqueduct is completely closed. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.







<- view MRI 5

MRI 5: FLAIR-Sequence: In the FLAIR-Sequences present tumor areas strong hyperintense.






<- view MRI 6

MRI 6: FLAIR-Sequence: In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor.
The brainstem is shifted towards ventral and the aqueduct is completely closed.

In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.






<- view MRI 7

MRI 7: FLAIR-Sequece transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate in the FLAIR-Sequences present tumor areas strong hyperintense.






<- view MRI 8

MRI 8: T1 TSE tra with contrast: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






<- view MRI 9

MRI 9: T1 TSE tra: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






<- view MRI 11

MRI 11: T1-TSE: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. Distinct increased dural enhancement supratentorial bilateral.




 

Surgery / Histo  

Germinal tumor of the pineal gland  

Pineoblastomas in childhood are less common at that location than germinal tumors. The prognosis is dependent from the operability of the tumor and the liquorgenic spreading.  

N/A  

N/A  

1. Medline:
A.J. Barkovich
Pediatric Neuroimaging  

Cerebral tumor, brain tumor, Pineoblastoma, emesis, ataxia, pineal gland, glandula pinealis, child, childhood, pediatric radiology  

G Hahn. Pineoblastoma. PedRad [serial online] vol 4, no. 12.
URL: www.PedRad.info/?search=20041206191142