Metastases outside the central nervous system from a presumed pineal germinoma. Case report.

A case of a presumed pineal germinoma in a 17-year-old boy is presented. Metastases in the left loin musculature developed 3 years after presentation, and on biopsy were found to be typical of a seminoma. Bone marrow and chest films showed no evidence of disease. It is therefore considered likely that spread occurred via the lumbar foramina by direct extension from known spinal metastases rather than via the ventriculoatrial shunt. The testes remained normal at all times, and a small testicular primary tumor giving rise to cerebral symptoms from mestastases is considered unlikely, since cerebral metastases from testicular tumors are rare without prior metastasis to the chest. Four previous cases of pineal tumors with chest metastases are reviewed.