Objective: To describe a patient with germinoma of pineal body who presented with anorexia and unexplained weight loss of 70 pounds. Case Summary: A 23-year-old man with no significant past medical history presented with nausea, vomiting, anorexia and weight loss of 70 pounds over a period of 6–8 months. Magnetic resonance imaging (MRI) scans demonstrated tumor lesions that were confirmed as germinoma histologically. A good treatment response to surgery, radiation, chemotherapy and alleviation of symptomatology was achieved. The postoperative neurological and MRI follow-up corresponded with the clinical course of the disease and the results of therapeutic procedures. Discussion: There were few reports of unexplained weight loss and anorexia, which was misdiagnosed as anorexia nervosa but later, found to be germinoma. Intracranial germinomas have a reported 90% survival to five years after diagnosis. Germinomas, like several other types of germ cell tumor, are sensitive to both chemotherapy and radiotherapy. Conclusions: In the initial stages, the differentiation of organic and functional symptoms and the diagnosis of central nervous system tumour may be difficult. Although their good prognosis, the review of available literature suggest that they are a diagnostic and therapeutic challenge. Our notices with this case signify the importance of considering organic disorder before making a diagnosis of depression or anorexia nervosa, particularly if the presentation is a typical. Through this case report, clinicians will be able to appreciate the need to be aware of germinoma as a possible cause of unexplained weight loss. Also, to bear in mind that the complaint of vomiting without a known etiology should facilitate considering a central cause.