 There is a pineal region mass that results in mass effect upon the midbrain tectum, aqueduct, and superior vermis. The mass enhances and demonstrates mild diffusion restriction compatible with high cellularity and measures 36 x 28 x 26 mm in the AP by transverse by CC dimensions (series 1202 image 39 and series 401 image 13). There are central punctate foci of susceptibility effect corresponding to calcification on recent CT. There is significant dilatation of the lateral and third ventricles unchanged from the recent CT. There is periventricular T2 hyperintensity compatible with subependymal CSF flow secondary to hydrocephalus. There is no definitely suprasellar mass, although the infundibulum is foreshortened due to the bulging third ventricular floor.There is no evidence of intracranial hemorrhage acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact.
Large enhancing pineal region mass with central calcifications and resultant obstructive hydrocephalus secondary to mass effect upon the aqueduct, with transependymal edema. While the appearance is most suggestive of a germ cell tumor, other pineal neoplasms remain with the differential.