Department of Radiology, Ankara Numune Training and Researching Hospital, Ankara, Turkey
Department of Pathology, Ankara Numune Training and Researching Hospital, Ankara, Turkey
Curr Med Imaging. 2020;16(8):1044-1047. doi: 10.2174/1573405615666191111143716.
Backround: Less than 1% of all intracranial tumors are in the pineal region. Papillary tumor of the pineal region is considered one of four pineal parenchymal tumors according to the 2007 World Health Organisation classification of central nervous system tumors. It is mostly seen in the middle age and it is rare under the age of 17 in the literature. In this report, we aim to present a case with papillary tumor of the pineal region with both CT and MRI findings, and discuss the differential diagnosis. Case report: A 17-year-old female patient who underwent a treatment of ventriculoperitoneal shunt due to hydrocephalus 18 months ago applied to the neurosurgery clinic with nausea, vomiting, sensorineural hearing loss and Parinaud syndrome continuing through 1 month. Computed tomography (CT) and magnetic resonance imaging (MRI) have been applied. A 58x31x38 mm mass with cystic and mild hyperdense soft tissue components was observed in the localization of pineal gland and posterior comissure on non-enhanced CT. MRI examination revealed that the mass filled the pineal region, contained solid and large cystic components, and hyperintense on T1-weighted images. After intravenous contrast media injection, the mass enhanced more peripherally. DW-MRI showed that there is a diffusion restriction in some parts of the soft tissue components. The mass was totally resected, and pathology report revealed that it is a papillary tumor of the pineal region. Conclusion: When a T1-weighted hyperintense and CT hyperdense mass with cystic and solid components is seen in the pineal region, even if it is rare, papillary tumor should also be considered in the differential diagnosis after exclusion of other hyperintense lesions in T1-weighted imaging.
颅内肿瘤中小于 1%位于松果体区。根据 2007 年世界卫生组织中枢神经系统肿瘤分类，松果体实质肿瘤分为四类，其中包括乳头状瘤。它主要发生在中年，文献中罕见 17 岁以下的病例。在本报告中，我们旨在介绍一例同时具有 CT 和 MRI 表现的松果体区乳头状瘤病例，并讨论鉴别诊断。
一名 17 岁女性，18 个月前因脑积水行脑室-腹腔分流术，因恶心、呕吐、感觉神经性听力损失和 Parinaud 综合征持续 1 个月就诊于神经外科。行计算机断层扫描（CT）和磁共振成像（MRI）检查。非增强 CT 显示在松果体和后连合定位处可见一个 58x31x38mm 的肿块，有囊变和轻度高密度软组织成分。MRI 检查显示肿块充满松果体区，包含实性和大囊变成分，T1 加权图像呈高信号。静脉注射对比剂后，肿块外周强化更明显。弥散加权 MRI（DW-MRI）显示部分软组织成分弥散受限。肿块完全切除，病理报告显示为松果体区乳头状瘤。
当在松果体区看到 T1 加权像高信号、CT 高密度、有囊变和实性成分的肿块时，即使罕见，在排除 T1 加权像中其他高信号病变后，也应考虑鉴别诊断为乳头状瘤。
