DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.032

Pages: 999-1003

Background: Pineal parenchymal tumor of intermediate differentiation [PPTID] is a rare central nervous system neoplasm representing an intermediate entity between pineocytoma and pineoblastoma. Due to its low incidence and heterogeneous behavior, optimal management strategies remain controversial, particularly regarding the role of adjuvant therapies. Case presentation: We report the case of a 38-year-old previously healthy woman who presented with rapidly progressive confusion and headaches, followed by aphasia. Brain magnetic resonance imaging revealed a well-defined pineal region mass causing obstructive hydrocephalus. The patient initially underwent endoscopic third ventriculostomy with biopsy, followed by near-total surgical resection via posterior occipital craniotomy. Histopathological examination confirmed a WHO grade II PPTID, with a low proliferative index [Ki-67 approximately 4%]. Staging investigations, including spinal MRI and cerebrospinal fluid cytology, showed no evidence of dissemination. The patient subsequently received focal adjuvant radiotherapy to the tumor bed [54 Gy in 30 fractions]. Follow-up imaging demonstrated no evidence of disease recurrence. Discussion: PPTIDs are rare tumors with nonspecific radiological features, making diagnosis challenging prior to histological confirmation. Surgical resection remains the cornerstone of treatment, while adjuvant radiotherapy is associated with improved local control, particularly in cases of incomplete resection. The role of craniospinal irradiation [CSI] remains debated and is generally reserved for patients with cerebrospinal fluid dissemination or high-risk features. In localized, low-grade disease, focal radiotherapy appears sufficient to achieve favorable outcomes. Conclusion: This case highlights the importance of a multidisciplinary approach in the management of PPTID. Maximal safe resection followed by focal radiotherapy can provide effective disease control in patients without evidence of