Pineal region metastasis with intraventricular seeding
Tumors of the pineal region are rare, accounting for less than 1% of primary intracranial lesions. Germ cell tumors, such as germinomas, teratomas, and yolk sac tumors, are the most frequent pineal tumors and others include pineal parenchymal tumors, glial tumors, cysts, meningiomas, and lipomas. However, metastatic neoplasms located in the pineal region are extremely uncommon.

A 51-year-old woman presented with a 1-week history of severe headache, nausea, and vomiting. Physical examination showed no convergence reflex and difficulty with upward gaze. Brain computed tomography (CT) scan revealed hydrocephalus and 1 lesion in the anterior horn of the right lateral ventricle and another in the posterior of the third ventricle. Magnetic resonance imaging (MRI) of the tumors demonstrated low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. The lesions enhanced heterogeneously after the administration of contrast media.

Pinealocytoma or germinoma was considered as the preoperative diagnosis. A right frontal craniotomy and a translateral ventricle approach were performed to remove 2 lesions completely. A third ventriculostomy was performed to relieve hydrocephalus. The postoperative pathology diagnosis was pineal metastasis of small cell neuroendocrine carcinoma.

Source: Medicine: August 2019

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