Department of Pathology, University of Oklahoma Health Sciences Center

February 2009, Case 902-1.

A 24 year-old man with a mass in the pineal area.

Clinical information: This patient was a 24 year-old Caucasian male who presented to the Emergency Department with a 6 month history of blurry vision with occasional diplopia and problems with horizontal eye movements.  Patient reports during the past 6 months he had also been experiencing increasingly severe headaches, fatigue, an unintentional loss of 70 lb in weight, decreased hearing bilaterally, and increased urination and thirst.  Patient reported no significant past medical history.  Family history was noncontributory.  Patient stated prior heavy alcohol use of 1 year duration, an eight pack year smoking history, and use of methamphetamine and cocaine. Physical exam revealed an overall slowness in mentation and movements.  Neurologic exam revealed paralysis of vertical gaze, loss of accommodation and a positive Romberg.  Abnormal laboratory values found included decreased luthenizing hormone (LH) of less than 0.1, decreased follicle stimulating hormone (FSH) of 0.45, and elevated prolactin of 34.48.  CSF studies showed carcinoembryonic antigen (CEA) less than 0.5, alpha fetal protein (AFP) less than 0.5 and elevated human chorionic gonadotropin (HCG) at 145.9. Both CT scan and MRI were performed and an endoscopic biopsy was performed. The followings are representative images form the imaging studies and pathologic specimen from the pineal gland.

Click thumbnails to see pictures.

Panel A is T1 weighed post-contrast MRI, Panel B is CT scan with contrast, Panel C to E are frozen sections, Panel F to H are permanent sections.

Cases of the Month  Evaluation  Coordinator: KarMing-Fung@ouhsc.edu

Copyrights reserved.