What is the most likely diagnosis in this 25 y/o M with headache? 🧠
Answer later tonight #radres #Neurology #Neurosurgery #MedEd #MedTwitter #NeuroTwitter @RSNA
Answer later tonight #radres #Neurology #Neurosurgery #MedEd #MedTwitter #NeuroTwitter @RSNA
Most likely diagnosis?
Answer: confirmed germinoma, all these masses are on the differential for a pineal region mass …perhaps the most helpful clue is the age and gender rather than the imaging 🧠
Germinoma cannot always be differentiated from pineoblastoma though the older age and male gender favor germinoma in this case as pineoblastoma typically occurs in younger children with a sight female predominance
Calcifications are also displaced and engulfed in this case rather than exploded or “blasted” and this tumor is very homogenous while pineoblastoma tends to be a bit more heterogenous
Meningioma arising from the tentorial cerebelli or falx can also look very similar though most commonly occur in older females around 5th-7th decades of life. Meningiomas tend to depress cerebral veins rather than uplift as pineal based masses do and may have a dural tail
There was no sellar lesion in this case, the mass effect caused the deformity of the pituitary stalk mimicking another lesion which resolved following resection
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