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case_images: (A) Computed tomography with contrast-enhancement axial view. (B) Computed tomography with contrast-enhancement sagittal view. A heterogeneous enhanced tumor mass over the pineal region is shown, approximately 3.8 cm, with ventricular dilatation, suspected pineal tumor with hemorrhagic transformation, and complicated hydrocephalus.
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case_images: Collier's sign, no ataxia, and no limb tremors were noted. Computed tomography revealed a heterogeneously enhanced tumor mass over the pineal region of approximately 3.8 cm with ventricular dilatation, a suspected pineal tumor with hemorrhagic transformation, and complicated hydrocephalus (Figure 1).
case_images: (A) T1 weighted with contrast-enhancement axial view. (B) T1 weighted with contrast-enhancement sagittal view. A lobulated heterogeneous enhancing tumor of the pineal region with foci of hemorrhage and calcifications is shown, suggesting pineal parenchymal tumor or metastasis. Moreover, mass effect with obstructive hydrocephalus and tectal plate compression were noted.
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case_images: In addition, a mass effect with obstructive hydrocephalus and tectal plate compression were noted (Figure 2).
case_images: (A) Hematoxylin and eosin stain; original magnification x 100. (B) Hematoxylin and eosin stain; original magnification x 200. A hypervascular tumor composed of lobules of tumor cells with uniform round nuclei is shown. Also, a hypercellular tumor but similar to the normal pineal gland was noted. No necrosis or mitotic figure is seen. No definite papillary structure is noted. (C) GFAP immunostaining; original magnification x 100. Immunohistochemical staining showed negative for glial fibrillary acidic protein (GFAP). (D) Synaptophysin immunostaining; original magnification x 100. Positive for synaptophysin. (E) Ki-67 proliferation index; original magnification x 200. The Ki-67 proliferation index is very low.
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case_images: The Ki-67 proliferation index was very low (Figure 3).
case_images: (A) T1 weighted with contrast-enhancement axial view. (B) T1 weighted with contrast-enhancement sagittal view. After 6 months of operation, a mild decrease of tumor volume was noted.
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case_images: The MRI was followed up 6 months after the operation, and a mild decrease in tumor volume was noted (Figure 4).
case_images: (A) T1 weighted with contrast-enhancement axial view. (B) T1 weighted with contrast-enhancement sagittal view. After 3 years of follow-up, the image showed no obvious change in the tumor volume.
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case_images: After 3 years of follow-up, the clinical condition was stable, and MRI showed no obvious change in the tumor volume (Figure 5).