Department of Neurosurgery, Carilion Clinic Neurosurgery, Roanoke, VA, United States.
Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.
Front Endocrinol (Lausanne). 2021 Mar 31;12:623756. doi: 10.3389/fendo.2021.623756. eCollection 2021.
Intracranial spread of a systemic malignancy is common in advanced staged cancers; however, metastasis specifically to the pineal gland is a relatively rare occurrence. A number of primary lesions have been reported to metastasize to the pineal gland, the most common of which is lung. However, metastasis of a bronchial neuroendocrine tumor to the pineal gland is a seldom-reported entity. Here, we present a 53-year-old female who presented with worsening headaches and drowsiness. MRI brain revealed a heterogeneously enhancing partially cystic mass in the pineal region. The patient had an extensive oncologic history consisting of remote stage IIA invasive breast ductal carcinoma as well as a more recently diagnosed atypical bronchopulmonary neuroendocrine tumor with lymph node metastases. She underwent microsurgical volumetric resection of the large pineal mass and a gross total removal of the tumor was achieved. Histopathology confirmed a metastatic tumor of neuroendocrine origin and the immunohistochemical profile was identical to the primary bronchopulmonary carcinoid tumor. Eight weeks after surgery, she underwent stereotactic radiosurgical treatment to the resection cavity. At 1-year follow-up, the patient remains clinically stable without any new focal neurological deficits and without any evidence of residual or recurrent disease on postoperative MRI. Metastatic neuroendocrine tumors should be considered in the differential diagnosis of pineal region tumors and aggressive surgical resection should be considered in selected patients. Gross total tumor resection may afford excellent local disease control. We discuss the relevant literature on neuroendocrine tumors and current treatment strategies for intracranial metastases of neuroendocrine origin.
颅内转移是晚期癌症的常见现象；然而，肿瘤直接转移至松果体的情况相对较少见。已有许多原发性肿瘤转移至松果体的报道，其中最常见的是肺癌。但是，支气管神经内分泌肿瘤转移至松果体的情况较为少见。在此，我们报告了一位 53 岁女性患者，她因头痛加重和嗜睡而就诊。头部 MRI 显示松果体区域有一个不均匀增强的部分囊性肿块。该患者有广泛的肿瘤病史，包括远处 IIA 期浸润性乳腺导管癌，以及最近诊断的具有淋巴结转移的非典型支气管肺神经内分泌肿瘤。她接受了松果体巨大肿块的微创手术切除，实现了肿瘤的大体全切除。组织病理学证实为神经内分泌来源的转移性肿瘤，免疫组织化学特征与原发性支气管类癌肿瘤相同。术后 8 周，她接受了立体定向放射外科治疗切除腔。术后 1 年随访时，患者临床状况稳定，无新的局灶性神经功能缺损，术后 MRI 未见残留或复发疾病的证据。在鉴别诊断松果体区域肿瘤时应考虑转移性神经内分泌肿瘤，并且应在选择的患者中考虑进行积极的手术切除。大体全切除可能会获得极好的局部疾病控制。我们讨论了神经内分泌肿瘤的相关文献和目前针对神经内分泌起源的颅内转移的治疗策略。
