Idiopathic pinealitis - Case report

This 63-year-old man presented with complaints of "having a feeling of fall ing backward" over a 3-month period. Results of his general physical examin ation, laboratory studies, and neurological examination were unremarkable. A magnetic resonance image revealed a 1.8 X 1.4 X 1.2-cm enhancing mass in the posterior third ventricle just above the corpora quadrigemina. The pine al gland was found to be diffusely enlarged at operation and separable from the posterior thalamus and was totally resected. The patient had an uneven tful postoperative course but continues to be somewhat confused. The lesion consisted of a remarkable chronic inflammatory cell infiltrate permeating the pineal lobules and was composed of T and B lymphocytes, macrophages, eo sinophils, and mast cells. Immunoperoxidase studies did not demonstrate Lan gerhans cells, and a search for microoganisms was unrevealing. There was no evidence of neoplasia; results of immunostaining for germ cell markers and other tumor-associated antigens were negative.