Germinoma, Pineal

28-year-old female undergoing MRI examination of the brain for evaluation of chronic headaches. Centered within the pineal region, there is a T1 isointense, T2/FLAIR hypointense mass without diffusion restriction and with signal dropout on the susceptibility weighted images. The lesion demonstrates mild, slightly heterogeneous, enhancement engulfing the pineal mineralizations. The differential included germinoma, pineoblastoma, intraventricular neurocytoma, or less likely cavernoma. On biopsy, this was found to be a germinoma. Germinoma are a type of germ cell tumor that are predominately seen in pediatric populations. They occur in the midline with the majority of lesions occurring in the pineal region or along the floor of the third ventricle and/or suprasellar region. The majority of patients are less than 20 years old at time of diagnosis. They are the most common type of pineal region tumor with males more commonly affected in the setting of pineal lesions. Treatment is typically with radiotherapy.