germ cell tumor with ependymal spread

An intensely enhancing irregularly marginated intraventricular low T2 intensity mass lesion measuring about 2.8 x 3.3 x 1.8 cm involving the fourth ventricle, epicentered along the ependymal margins infiltrating into the periventricular white matter associated with a similar vividly enhancing mass lesion epicentered at the suprasellar cistern, involving the infundibular recess, optic recess with marked thickening of the the pituitary infundibulum, mammillary body along with thick irregularly enhancing ependymal margins of bilateral lateral ventricles predominantly at the level of frontal horns involving the septum pellucidum, fornix, medial margins of bilateral thalami,– of concern for neoplastic etiology, likely germ cell tumor (esp. embryonal carcinoma or mixed GCT) versus ependymoma versus ? lymphoma with ependymal spread.

Minimal obstructive hydrocephalus.

Recommend serum / CSF markers such as AFP, β-HCG, CSF cytology, HPE, follow up.

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Compared with prior study dated 25-March-2025 There is marked interval increase in the extent of the lesions and interval appearance of multiple new lesions at the suprasellar region, fourth ventricle, thalamus, which are new onset since prior study suggesting rapidly progressive lesion