[Simultaneous suprasellar and pineal germinoma: a case report]

Tumours in the pineal region are rare (0.3-2.7%) and most of the ones that do occur are germ cell tumours, of which germinoma is the most frequent. They are chiefly located in the pineal gland, the next most common being site being the suprasellar region and the fourth ventricle, although simultaneous presentation in these locations is relatively rare (5-10% of cases). The main aim of this study is to review the differential diagnosis of neoplasias in the pineal region.

Here we report the case of a 20-year-old male who was admitted to hospital due to irregularities affecting the field of vision, with clinical signs and symptoms of panhypopituitarism and normal levels of tumour markers in blood and cerebrospinal fluid. Magnetic resonance imaging of the craniospinal axis was performed and results showed the presence of two masses with significant enhancement, one located in the pineal region with a signal similar to that of grey matter and the other in the hypothalamus, which had a more heterogeneous aspect with cystic areas inside it. Imaging with paramagnetic contrast agents revealed dissemination with ependymal uptake in relation to the frontal horns and in the fourth ventricle; a possible simultaneous origin was also suggested in this latter location.

Magnetic resonance imaging plays a decisive role in establishing the diagnosis and therapy plan. The imaging factors that must be taken into account are the origin of the mass, heterogeneity, contrast enhancement, presence of fat or calcium, a signal similar to that of grey matter and possible dissemination, above all into the subarachnoid space. The patient's medical record (age, sex or tumour markers) must also be taken into consideration.