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Primary malignant melanoma of the pineal region: illustrative case
Jiahong Xu1, Jibo Hu1, Zhenwei Chen2
1Department of Radiology, the Fourth Affiliated Hospital School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China.
Background:
Primary pineal melanoma is a rare tumor characterized by a high propensity for progression and recurrence. The imaging complexity of the melanoma will pose significant challenges for preoperative diagnosis. Definitive diagnosis necessitates histopathological examination.
Observations:
The authors present the case of a 49-year-old woman presenting with headache accompanied by nausea and vomiting. Imaging revealed a pineal tumor with subarachnoid hemorrhage. She underwent her first craniotomy at another hospital. Four months after surgery, she was sent to the authors' hospital for a second craniotomy due to recurrent cerebral hemorrhage. The postoperative pathological diagnosis was malignant melanoma in the pineal region.
Lessons:
In this case, malignant melanoma in the pineal region recurred rapidly and involved the ventricles only 4 months after surgery, suggesting the necessity of close follow-up for rare tumors. In addition, diagnosing this type of tumor on preoperative imaging is challenging, and although pathological diagnosis is the gold standard, the patient in this case required repeat pathological analysis for a definitive diagnosis to be made. https://thejns.org/doi/10.3171/CASE25242.
Insights
Primary pineal melanoma is a rare and aggressive tumor. This case highlights the diagnostic challenges and rapid recurrence of pineal melanoma, emphasizing the need for close patient monitoring and advanced pathological analysis.
Area of Science:
- Neuro-oncology
- Pathology
Background:
- Primary pineal melanoma is a rare tumor with high recurrence rates.
- Preoperative diagnosis is challenging due to imaging complexities.
- Histopathological examination is essential for definitive diagnosis.
Purpose of the Study:
- To present a case of primary pineal melanoma.
- To illustrate diagnostic challenges and rapid recurrence.
- To emphasize the importance of close follow-up for rare pineal tumors.
Main Methods:
- Case report of a 49-year-old woman with a pineal tumor.
- Review of clinical presentation, imaging, and surgical history.
- Postoperative pathological diagnosis of malignant melanoma.
Main Results:
- The patient presented with headache, nausea, and vomiting.
- Imaging revealed a pineal tumor with subarachnoid hemorrhage.
- Malignant melanoma in the pineal region recurred rapidly within 4 months, involving the ventricles.
Conclusions:
- Pineal region melanoma can recur rapidly postoperatively.
- Close follow-up is crucial for patients with rare pineal tumors.
- Preoperative imaging diagnosis is difficult, and repeat pathological analysis may be needed.
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