We are reporting a case involving a 25-year-old male patient who presented with mild headaches. A hyperdense mass in the pineal region was observed during a computed tomography scan. Subsequent magnetic resonance imaging revealed a heterogeneous mass in the pineal region, which did not exhibit contrast enhancement. The initial radiographic differential diagnoses included a germ cell tumor (teratoma) or an unusual fat-containing tumor, such as a lipoma. However, the patient’s tumor marker levels, including alpha-fetoprotein and beta-human chorionic gonadotropin, were within normal ranges. The patient underwent surgical resection, during which intraoperative findings indicated a relatively firm, whitish tumor. The mass was grossly total removed, and the patient recovered well without experiencing any neurological deficits. Histopathological examination of the excised tissue revealed a cyst lined by squamous epithelium, including keratin pearls, consistent with an epidermoid cyst. This case report highlights an unusual epidermoid cyst located in the pineal gland region, characterized by atypical radiological findings that posed challenges in achieving an accurate preoperative diagnosis.
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