Primary Malignant Melanoma in the Pineal Region

Abstract

A 59-year-old male patient had 5-month history of gait disturbance and memory impairment. His initial brain computed tomography scan showed 3.5×2.8 cm sized mass with high density in the pineal region. The tumor was hypointense on T2 weighted magnetic resonance images and hyperintense on T1 weighted magnetic resonance images with heterogenous enhancement of central portion. The tumor was totally removed via the occipital transtentorial approach. Black mass was observed in the operation field, and after surgery, histopathological examination confirmed the diagnosis of malignant melanoma. Whole spine magnetic resonance images and whole body 18-fluoro-deoxyglucose positron emission tomography could not demonstrate the primary site of this melanoma. Scrupulous physical examination of his skin and mucosa was done and dark pigmented lesion on his left leg was found, but additional studies including magnetic resonance images and skin biopsy showed negative finding. As a result, final diagnosis of primary pineal malignant melanoma was made. He underwent treatment with the whole brain radiotherapy and extended local boost irradiation without chemotherapy. His preoperative symptoms were disappeared, and no other specific neurological deficits were founded. His follow-up image studies showed no recurrence or distant metastasis until 26 weeks after surgery. Primary pineal malignant melanomas are extremely rare intracranial tumors, and only 17 cases have been reported since 1899. The most recent case report showed favorable outcome by subtotal tumor resection followed by whole brain and extended local irradiation without chemotherapy. Our case is another result to prove that total tumor resection with radiotherapy can be the current optimal treatment for primary malignant melanoma in the pineal region.

Targeting PD-L1 After Adjuvant Radiation in Subtotally Resected Primary Pineal Melanoma: A Case Report and Literature Review

“…Of the 10 patients reported to have undergone attempted surgical resection, only 2 have successfully achieved a GTR. [1][2][3][4][5][6][7][8][9][10] Due to incomplete survival data in previously published literature, it is not possible to infer the benefit of GTR over STR in these patients. Previously published case reports pertinent to this discussion can be found in Table 1.…”

“…Previously published case reports pertinent to this discussion can be found in Table 1. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Given the recent development of targeted and immunotherapeutic regimens, attempts at GTR should be tempered by maximal preservation of neurologic function. What does seem to be apparent is that STR without any adjuvant therapy is associated with a poor prognosis.…”

“…There have been 16 cases presented in the literature that have undergone STR or biopsy, with survival follow-up data also reported. [1][2][3][4][5][6][7][8][9][10][12][13][14][15][16] Among the 3 patients with STR who did not receive adjuvant therapy, the reported OS were 4, 5, and 12 weeks. 7,12,17 Given this dismal prognosis, it seems prudent to strongly recommend adjuvant therapy after resection, particularly in the event of an STR.…”

“…resection, and all but 1 have received radiation in some form. [1][2][3][4][5][6][8][9][10][13][14][15]16 Radiation techniques in these series include WBRT, conventionally fractionated RT, SRS, or some combination of these. The data are not sufficiently robust to analyze differences between RT techniques.…”

Keyhole surgery of pineal area tumors - personal experience in 22 patients

“…The most prevalent pineal tumors are pineocytomas, pineoblastomas and primitive neuroectodermal tumors (PNET) [ 3 , 4 , 5 , 6 , 7 , 8 ]. In addition, glioblastomas [ 9 , 10 ], metastatic tumors [ 11 , 12 ], vascular malformations [ 13 ], papillary tumors [ 14 ], meningiomas [ 5 , 16 ] and neurocytomas [ 17 , 18 ] can also occur.…”