Abstract
Pineal metastasis is an exceedingly rare finding in patients with systemic malignancies. Such lesions are typically the manifestation of a primary lung cancer; nonetheless, a variety of malignancies have been reported to disseminate to the pineal gland including gastrointestinal, endocrine, and skin cancers, among others. However, to our knowledge, pineal gland metastasis without a primary origin has yet to be described. Carcinoma of unknown primary origin is a heterogeneous group of cancers characterized by the presence of metastatic disease without an identifiable primary tumor on metastatic workup. Here, we present a case of a 65-year-old male found to have a heterogeneously enhancing lesion of the pineal gland as well as an enhancing lesion of the left cerebellar hemisphere. Comprehensive metastatic workup demonstrated multifocal metastatic adenopathy without an identifiable primary lesion. Stereotactic biopsy of the pineal lesion revealed poorly differentiated carcinoma with an immunophenotype most consistent with gastrointestinal origin. To our knowledge, this is the first case to describe a pineal gland metastasis without a primary origin. We discuss the relevant literature on pineal gland metastases as well as carcinoma of unknown primary origin.
Highlights
Pineal region tumors are a rare entity constituting approximately 1% of all intracranial tumors in the adult population [1]
Carcinoma of unknown primary origin (CUP) is a heterogeneous group of cancers defined by the presence of metastatic disease without an identifiable primary tumor on metastatic workup [5, 6]
We discuss the relevant literature on pineal gland metastases as well as carcinoma of unknown primary origin
Summary
Pineal region tumors are a rare entity constituting approximately 1% of all intracranial tumors in the adult population [1]. Carcinoma of unknown primary origin (CUP) is a heterogeneous group of cancers defined by the presence of metastatic disease without an identifiable primary tumor on metastatic workup [5, 6]. Stereotactic biopsy of the pineal lesion revealed poorly differentiated carcinoma with an immunophenotype most consistent with gastrointestinal origin. To our knowledge, this is the first case to describe a pineal gland metastasis from CUP. Given the immunophenotype of the lesion and a small minority of tumor cells exhibiting signet ring features, the patient was referred to a gastroenterologist who recommended esophagogastroduodenoscopy with possible biopsy of any identifiable abnormal tissue.
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