Neoplasm of unspecified nature of endocrine glands and other parts of nervous system [239.7], Reason for Study: ^Reason: Change in pineal germinoma s/p 4 cycles of chemotherapy? History: 16 year old with pineal germinoma. Interval reduction of the size of solidly enhancing pineal as well as minimally enhancing more mixed cystic and solid bilateral mesial thalamic lesions comparing to prior scan.In particular, the size of solid enhancing pineal lesion is now measured about 9.4mm x 11.4mm (was 17.4mm x 16.1mm on corresponding image) on the sagittal post enhanced scan, and the mixed cystic and solid lesion is measured about19.5mm x 22.2mm on coronal T2 weighted image (was 23.9mm x 26.2mm on corresponding images).Bone marrow signal appears to be normal.No evidence of meningeal enhancement.Ommaya catheter is seen inserted through the right frontal burr hole and the tip is located in the right side of foramen of Monroe, no change since prior scan.No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable, no change since prior scan.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Interval reduction in size of both pineal solid enhancing lesion and mixed cystic solid lesion on bilateral thalami since prior scan.2. No change in ventricle size and ventriculostomy tube location since prior scan. 3. No evidence of new enhancing lesion. No evidence of acute ischemic or hemorrhagic lesion on this scan.