Pineal metastasis as first clinical manifestation of colorectal adenocarcinoma: case report

Abstract

ABSTRACT-Cerebral metastases from colorectal adenocarcinomas occur in 8% of the cases. Diagnosis is usually made when primary disease and widespread metastases are already known. We report the case of a patient with single metastases in the pineal region as the first clinical manifestation of a colorectal adenocarcinoma. A 48-year-old female with Parinaud's syndrome for 15 days prior her admission was evaluated in our clinic. She had no symptoms or signs of colorectal disease. MRI examination revealed an heterogeneous lesion with peritumoral gadolinium enhancement, located in the pineal region. The tumor was radically resected through an infratentorial/supracerebellar approach. Histology showed metastatic carcinoma and immunohistochemical examination showed gastrointestinal tract adenocarcinoma. Metastases to the pineal region are extremely rare and should be considered in the differential diagnosis of tumors of this region.KEY WORDS: pineal tumors, cerebral metastases, colorectal adenocarcinoma. Metástase pineal como primeira manifestação clinica de adenocarcinoma colorretal: relato de casoRESUMO -Metástases cerebrais derivadas de adenocarcinomas colorretais ocorrem em 8% dos casos. Geralmente a doença primária e as metástases em outros órgãos já são conhecidas quando do momento das manifestações neurológicas. Descrevemos um caso de metástase única na região pineal que promoveu a primeira manifestação clínica de adenocarcinoma colorretal. Uma mulher de 48 anos de idade apresentava há quinze dias de sua admissão ao nosso serviço diplopia e síndrome de Parinaud . O exame de ressonância magnética revelou lesão heterogênea localizada na região pineal. O tumor foi completamente retirado por acesso infratentorial/supracerebelar. O exame histológico revelou tumor metastático indiferenciado e o exame imuno-histoquímico demostrou adenocarcinoma do trato gastrointestinal moderadamente diferenciado. Metástases para a região pineal são extremamente raras e devem ser consideradas no diagnóstico diferencial de tumores nesta região.

Lung carcinoma metastasis presenting as a pineal region tumor

“…Pineal metastasis used to be found at autopsy 3,10,14,16,22 in older cases but more recently due to better diagnostic imaging, CT and/or MRI has detected such lesions 1,[14][15][16][17]19,25,28,33,35 which would previously have been subclinical. A literature review suggested that lung carcinoma was the most frequent primary lesion responsible 1,2,10,16,17,22,23,33,35 .…”

“…In these cases, histologically small cell carcinoma 1,16,17,23,35 and undifferentiated carcinoma 10,22,33 are frequently seen, although other histological types including squamous cell carcinoma 10 and adenocarcinoma 14,22 have also been reported. Carcinomas in other organs, such as breast 22 , stomach [13][14][15]36 , esophagus 19,22 , rectum 19,25 and kidney 19,23 have been reported as primaries. Occasionally plasma cell leukemia 12,31 , lymphoma, multiple myeloma, melanoma 6,22,33 , melanocytoma 4 and frontal sinus malignancy constituted a solitary tumor mass in the pineal region.…”

“…Pineal region metastasis is even rarer and accounted for only 1.8% to 4% in literature 3,8,22,29 . In approximately half of reported cases, the pineal gland was the only site of intracranial metastasis with variable sizes 1,2,16,17,25,28,33,35 . The most common site of primary origin is lung carcinoma, followed by breast carcinoma and malignant melanoma 33 .…”

Zerebrale Metastasen bei kolorektalen Karzinomen

“…In Einzelfällen manifestieren sich zerebrale Metastasen vor der Sicherung des kolorektalen Karzinoms [27,32]. Bei einer unserer 13 Patienten wurde 2 Monate vor Diagnose eines Zökum-karzinoms eine singuläre Metastase des Parietalhirns entfernt.…”

Metastatic Pineal Tumors Treated by Neuroendoscopic Surgery -Two Case Reports-

“…5) To date, approximately 180 metastatic tumors of the pineal region have been reported but discovery was posthumous in most cases. 1,[3][4][5][6][7][8][9][10][11][12][14][15][16][17][18][19][20][21] Table 1 summarizes the clinical features of 33 reported cases with metastases in the pineal gland that were symptomatic and diagnosed in life. The mean age of the patients was 58.3 ± 12.5 years.…”