Department of Radiation Oncology, Institute of Oncology, SRM Institute for Medical Sciences, Chennai, Tamil Nadu, India.
Department of Neurosurgery, Institute of Neurosciences, SRM Institute for Medical Sciences, Chennai, Tamil Nadu, India.
J Cancer Res Ther. 2020 Oct-Dec;16(6):1532-1534. doi: 10.4103/jcrt.JCRT_762_19.
Pineal gland metastasis accounts for approximately 0.4% of all intracranial metastases from lung primary. Our patient was a 60-year-old female presenting with intermittent headache and altered sensorium. Magnetic resonance imaging brain showed a 21 mm × 18 mm × 16 mm pineal lesion with obstructive hydrocephalus. She underwent endoscopic third ventriculostomy and drainage. Fluorodeoxyglucose-PET showed a left lung primary tumor with nodal metastasis and solitary pineal gland metastasis. Biopsy of lung lesion revealed poorly differentiated non-small-cell carcinoma which was treated with focal pineal radiation and chemotherapy. This patient's presentation is unique because she presented with pineal symptoms rather than lung symptoms. Pineal gland metastasis from lung primary is mostly associated with small-cell carcinoma histology, but this patient had a non-small-cell carcinoma of lung primary. The age above 60 years is in favor of a metastatic lesion to the pineal gland. Our experience suggests that systemic evaluation of all patients presenting initially with an isolated pineal gland tumor is mandatory.
松果体转移瘤约占所有颅内转移瘤的 0.4%，来源于肺部原发性肿瘤。本例患者为 60 岁女性，表现为间歇性头痛和意识改变。颅脑磁共振成像显示 21mm×18mm×16mm 松果体占位病变，伴有梗阻性脑积水。患者接受了内镜下第三脑室造瘘术和引流术。氟脱氧葡萄糖-PET 显示左肺原发性肿瘤伴淋巴结转移和孤立性松果体转移。肺部病变活检显示低分化非小细胞癌，给予局部松果体放疗和化疗。该患者的表现较为独特，因为她以松果体症状而非肺部症状为首发表现。源自肺部原发性肿瘤的松果体转移瘤多与小细胞癌组织学相关，但该患者的肺部原发性肿瘤为非小细胞癌。年龄大于 60 岁有利于松果体转移瘤的发生。我们的经验表明，对于最初表现为孤立性松果体肿瘤的所有患者，必须进行全身评估。
