Pineocytoma with diffuse dissemination to the leptomeninges

Area of Science:

• Neuro-oncology
• Neurosurgery
• Radiation Oncology

Background:

• Pineal parenchymal tumors are rare central nervous system neoplasms.
• Pineocytomas are the least aggressive subtype, typically not known for diffuse dissemination.
• Leptomeningeal dissemination is an uncommon but serious complication.

Observation:

• A 39-year-old female presented with neurological symptoms including headaches, balance impairment, urinary incontinence, and blunted affect.
• Magnetic resonance imaging (MRI) revealed a pineal mass, diagnosed as pineocytoma via endoscopic biopsy.
• The patient initially received stereotactic radiotherapy for the pineal mass.

Findings:

• Ten years post-initial treatment, the patient developed diffuse leptomeningeal dissemination.
• The patient was successfully treated with craniospinal radiation therapy for the leptomeningeal relapse.
• This case demonstrates that leptomeningeal spread from pineocytoma can occur as late as 10 years after initial diagnosis.

Implications:

• Long-term follow-up is crucial for patients with pineal parenchymal tumors, even those treated with radiotherapy.
• Craniospinal radiation therapy is an effective treatment modality for late-onset leptomeningeal dissemination of pineocytoma.
• This case expands the understanding of the potential clinical behavior and treatment outcomes for pineocytoma.