A 50 year lady presented with altered sensorium and weakness of the both lower limbs since 6 months.Neurological examination showed bilateral papilloedema. There was restriction of upward gaze with gait ataxia. MRI brain showed a 3x3 cm well defined, heterogeneously enhancing lesion in the posterior part of the third ventricle causing obstructive hydrocephalus (Fig 1). A ventriculoperitoneal shunt was performed followed by partial excision of the lesion through a supracerebellar–infratentorial approach. The tumour was grayish, soft, suckable and vascular. Histopathology showed a cellular tumour arranged in sheets and papillae, with perivascular arrangement at places, some vessels having a hyalinized cuff (Fig 2). The tumour cells were round to oval with central nucleus, moderate nuclear pleomorphism, granular chromatin and moderate amount of eosinophilic, dense cytoplasm. A rare mitosis was seen but necrosis or endocapillary proliferation was not evident. On immunohistochemistry, pancytokeratin and vimentin were positive with a paranuclear accentuation. Chromogranin was positive in a cytoplasmic and paranuclear dot pattern. These features were consistent with a papillary tumour of the pineal region. Post operatively the patient was given radiotherapy (6140cGy in 25 fractions). Follow up at 1 and 2 years show no residual or recurrent tumour.