Isolated pineal region metastasis from lung adenocarcinoma with obstructive hydrocephalus: a case report

Abstract

IntroductionAlthough the brain is a common site of metastasis from lung cancer, pineal region metastasis from lung adenocarcinoma is rare. Most cases of pineal metastases are asymptomatic, and are diagnosed by autopsy. Therefore, the management of pineal region tumors remains controversial. Here, we present a rare case of lung carcinoma presenting with pineal region metastasis and obstructive hydrocephalus as the first manifestation of the lung adenocarcinoma.Case presentationA 63-year-old Japanese woman was referred to our hospital for treatment of a tumor of the pineal region associated with hydrocephalus. On admission, she was found to have a mass in her right lung on a chest radiograph. During the preoperative investigation, the patient began to show a progressively worsening level of altered consciousness. Therefore, neuroendoscopic surgery was performed as an emergency procedure, which resulted in improvement of the hydrocephalus and diagnosis of adenocarcinoma. A systematic investigation revealed adenocarcinoma of her right lung as the primary lesion. She was treated by a platinum-based chemotherapy regime. Stereotactic radiation to the pineal region was undertaken concurrently. After completion of the chemotherapy, the primary lesion and pineal region metastasis showed good partial response.ConclusionThe prognosis of pineal region metastasis is extremely poor, and only three patients with metastatic pineal region metastasis from lung cancer who were treated by chemotherapy have been reported. We performed neuroendoscopic surgery to obtain resolution of the obstructive hydrocephalus and the definite histological diagnosis. This resulted in improvement of the general condition of the patient, and the patient could be treated by chemotherapy and radiotherapy. We strongly believe that neuroendoscopic surgery was a good option in this case. This case report suggests that in the presence of an isolated pineal region tumor, metastasis should be considered a possible diagnosis, and careful examination for systemic malignant disease will be needed.

Unique Case Report of Pineal Gland Metastasis From Bladder Carcinoma

“… 1 The most commonly reported primary tumors are lung carcinomas. 2 – 4 The case presented here represents, as far as we are aware, the first report of a pineal gland metastasis from a bladder carcinoma.…”

“…Metastasis to the pineal gland is most frequently found in lung cancer. 2 – 4 Previous cases also reported pineal region metastases caused by other tumors such as esophagus, pancreas, kidney, stomach, colon, melanoma, and myeloma. 1 , 5 – 7 Here we present, to the best of our knowledge, the first case of a bladder carcinoma metastatic to the pineal gland.…”

Parinaud′s syndrome: A rare presentation of lung carcinoma with solitary pineal metastasis

“…In fact, metastasis to the pineal region has been estimated to account for only 0.4% of all intracranial metastatic tumors. [ 1 ] A review of the literature revealed that the most common site of primary origin of a pineal metastasis is the lung and histologically, small cell lung carcinoma is the most frequent type of cancer. Most cases of pineal metastases are asymptomatic, and are diagnosed during autopsy.…”

“…Pineal metastases used to be identified on autopsy as majority of them remained asymptomatic or were masked by the features of either a primary or by associated brain metastases. [ 1 2 ] Since the advent and widespread use of MRI Brain, more number of asymptomatic pineal region metastases has been reported. The most frequently reported histological type of lung cancer metastasizing to the pineal region is small cell carcinoma, in this case report the patient had adenocarcinoma; the metastasis of this histological type to the pineal region is rare.…”

“…The most frequently reported histological type of lung cancer metastasizing to the pineal region is small cell carcinoma, in this case report the patient had adenocarcinoma; the metastasis of this histological type to the pineal region is rare. [ 1 ] The solitary metastasis to the pineal region poses a diagnostic dilemma, whether it is a solitary metastases or a pineal tumor itself. Most patients with primary pineal tumors are reported to be younger than 30 years old, and metastasis should be considered in older patients.…”