A mass in the pineal region of a young woman

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This case involves an 18-year-old female with no significant past medical history who was found to have a large pineal and third ventricular tumor with obstructive hydrocephalus after experiencing subacute, progressive headaches, and an acute episode of sudden vision loss.She underwent a ventriculoperitoneal shunt at an outside facility with improvement in her vision before presenting as a transfer to our facility.Brain magnetic resonance imaging upon transfer demonstrated a large, heterogenous enhancing mass (6.6 Â 6.1 Â 5.7 cm) centered in the pineal region with extension into the third and right lateral ventricles (Figure 1).The tumor exerted mass effect by splaying the bilateral thalami with effacement of the basal cisterna, effacement of the cerebral aqueduct, and an 8 mm tonsillar herniation.Surgery was pursued for a definitive diagnosis and tumor debulking.Intraoperatively, the tumor demonstrated variable soft and firm consistency with moderate vascularity.Post-operative imaging did not demonstrate clear residual tumor.She was discharged with no new neurologic deficits.

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