case_images: PMC10201390_01
case_images: A hyperdense lesion in the pineal region on non-enhanced CT
  examination.
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case_images: The non-enhanced brain CT revealed a hyperdense lesion in the pineal region and lateral ventricles (Figure 1).
case_images: (A) T1-weighted axial magnetic resonance image shows a hypointense lesion
  in the pineal region. (B) T2-weighted axial view shows an isointense
  lesion with perifocal edema in the pineal region. (C) T2 fluidattenuated
  inversion recovery (FLAIR) axial view shows an isointense lesion with
  perifocal edema in the pineal region. (D) T1 axial view with contrast
  shows an enhanced lesion in the pineal region. (E) T1 coronal view with
  contrast shows an enhanced lesion in the pineal region and ventricles.
  (F) T1 sagittal view with contrast shows an enhanced lesion in the
  pineal region and ventricles.
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case_images: After admission, a brain MRI confirmed a pineal tumor with hemorrhage (Figure 2).
case_images: Histological analysis reveals that the moderate tumor cells are composed
  of small round cells, most of which have uniform nuclei, fine chromatin,
  and small nucleoli. Low to moderate levels of mitotic activity and
  nuclear atypia are observed.
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case_images: Low to moderate mitotic activity and nuclear atypia were observed (Figure 3).
case_images: Small irregular flower-like pineocytomatous rosettes are focally
  observed.
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case_images: Some small, irregular, and flower-like pineocytomatous rosettes were focally observed (Figure 4).
case_images: The darker staining in immunohistochemistry is positive for
  synaptophysin.
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case_images: Immunohistochemical analysis revealed that the tumor was positive for synaptophysin (Figure 5), neurofilament protein (Figure 6), and neuron-specific enolase.
case_images: The darker staining in immunohistochemistry is positive for neurofilament
  protein.
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case_images: Immunohistochemical analysis revealed that the tumor was positive for synaptophysin (Figure 5), neurofilament protein (Figure 6), and neuron-specific enolase.
case_images: The Ki-67 proliferation index is 12% (observed as darker staining in this
  figure).
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case_images: The Ki-67 proliferation index was 12% (Figure 7).
case_images: The postoperative non-enhanced CT 2 weeks after the subtotal tumor
  resection shows an isodense lesion (asterisk) in the pineal region. The
  size of the tumor was about 2.3 cm.
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case_images: Two weeks after the subtotal tumor removal surgery, a non-enhanced brain CT scan showed a residual tumor in the pineal region and lateral ventricles (Figure 8).
case_images: The follow-up non-enhanced brain CT 1-year and 5-month after the subtotal
  tumor resection shows an isodense lesion (asterisk) in the pineal
  region. The size of the tumor was about 1.8 cm.
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case_images: The patient remained asymptomatic until the 1-year and 11-month follow-up visit (Figure 9).