J Korean Soc Radiol.  2014 Sep;71(3):103-106. 10.3348/jksr.2014.71.3.103.

Pineal Gland Metastasis as the Initial Presentation of Squamous Cell Lung Cancer: A Case Report

• Park WH
• Song CJ
• Kim DM
• Lee IH

• KMID: 1736473
• DOI: http://doi.org/10.3348/jksr.2014.71.3.103

Abstract

The pineal gland is an unusual site for brain metastasis, and a solitary pineal gland metastasis is rare. A 71-year-old man presented with dizziness, gait disturbance, and memory impairment. Brain computed tomography revealed a solitary hyperdense mass with central calcification in the pineal region and obstructive hydrocephalus. Brain magnetic resonance images showed a heterogeneously enhancing mass with intratumoral calcification and microcysts. Metastatic squamous cell carcinoma was diagnosed following an endoscopic biopsy. A systemic review revealed that the primary site of the carcinoma was the lung. Although rare, metastasis should be considered in the differential diagnosis of pineal region tumors, especially in elderly patients with a pineal tumor that presents unusual imaging findings.

MeSH Terms

Aged
Biopsy
Brain
Carcinoma, Squamous Cell
Diagnosis, Differential
Dizziness
Gait
Humans
Hydrocephalus
Lung
Lung Neoplasms*
Magnetic Resonance Imaging
Memory
Neoplasm Metastasis*
Pineal Gland*
Pinealoma
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 A non-contrast-enhanced axial CT image shows a solitary well-defined hyperdense (50 Hounsfield units) mass (arrow, A) with central calcification in the pineal region. A well-defined lobulated mass in the pineal area shows intemediate signal intensity on axial T1 weighted images (WI) (B) and isosignal intensity on T2WI (C). There is no restricted diffusion on diffusion-weighted imaging (D). The mass contains a central dark signal intensity focus due to the engulfment of pineal calcification on gradient echo image (arrow, E), and T2 high signal intensity foci of microcysts (arrow, C). Contrast-enhanced sagittal T1WI (F) shows heterogeneous enhancement of the tumor. The pineal mass results in obstructive hydrocephalus (asterisk, F).

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  Fig. 2 Histopathologic examination (hematoxylin and eosin stain, × 200) show proliferation of atypical stratified squamous cells with keratin, which is suggestive of squamous cell carcinoma.

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  Fig. 3 A contrast-enhanced chest CT image shows a central mass (asterisk) in the right middle lobe of the lung and associated atelectasis (arrow).

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