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Case Reports
. 2022 Oct 3;14(10):e29855.
doi: 10.7759/cureus.29855. eCollection 2022 Oct.

Pineal Gland Tumour With Drop Metastases: A Case Report

Shelva Meena Gurusamy  1 , Azhany Yaakub  1 , Wan-Hazabbah Wan Hitam  1 , Siti Aishah Ahmad Maulana  2 , Wan Zulkafli Wan Ibrahim  3
Affiliations
Case Reports

Pineal Gland Tumour With Drop Metastases: A Case Report

Shelva Meena Gurusamy et al. Cureus. .

Abstract

Pineal gland tumours are reported rarely in Malayasia and early diagnosis and intervention promise a better prognosis for patients. We report a rare case of pineal gland tumour with drop metastases in the fourth ventricle in a 20-year-old young male with Parinaud syndrome. The patient, who had no underlying medical illnesses, presented with neurological symptoms and limb weakness associated with tremors and blurring of vision which worsened over a span of four months. The patient was having difficulty in ambulating with reduced power over the lower limbs with tremors as well as Parinaud syndrome indicated through the limitation of upward gaze, light-near dissociation of the pupils and convergence nystagmus. An MRI showed the presence of a pineal gland tumour with drop metastases in the fourth ventricle with calcification. The patient underwent an endoscopic third ventriculostomy and tumour biopsy. The biopsy indicated a pineal gland tumour with a germinoma subset and the patient was subjected to radiotherapy. Latency of diagnosis is an important prognostic factor as it reduces the survival rate for these patients hence the following discussion on the pineal gland tumour and its diagnostic dilemma.

Keywords: germinoma; neurological manifestations; parinaud syndrome; pineal gland tumor; young.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Hess test showing right eye hypotropia with limitation of upward gaze. There is compensatory upward gaze in the left eye
Figure 2
Figure 2. CT brain axial showing hyperdense lesion in the pineal gland region measuring 2.2 cm x 2.6 cm x 1.8 cm (yellow arrow).
Figure 3
Figure 3. CT brain sagittal showing hypodense lesion in the right lateral and posterior wall of the fourth ventricle measuring 2.1 cm x 3.3 cm x 2.2 cm (yellow arrow)
Figure 4
Figure 4. MRI brain (T1) axial showing an ill-defined lesion in the fourth ventricle, appearing isointense (yellow arrow)
Figure 5
Figure 5. Enhanced MRI brain (T1) axial post-contrast showing an ill-defined lesion in the fourth ventricle (yellow arrow)
Figure 6
Figure 6. MRI brain (T1) sagittal showing an ill-defined lesion measuring 2.1 cm x 2.1 cm x 1.7 cm (yellow arrow)
See this image and copyright information in PMC

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