Pineal gland metastasis
Increasing headache and abdominal pain with liver mass.
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MRI demonstrating a large pineal region mass with low signal intensity on T1WI and high signal intensity on T2/FLAIR that cannot be separated from the tectal plate, and the normal pineal gland is not seen.
It protrudes anteriorly into the third ventricle and posteriorly into the quadrigeminal cistern and compresses the cerebral aqueduct resulting in obstructive hydrocephalus with interstitial edema. Midbrain is compressed with the mass without edema. Contrast-enhanced T1WI showing tumor with significant homogeneous enhancement.
The patient underwent surgical treatment for removal of the neoplastic mass. Histopathology findings confirmed metastatic adenocarcinoma from a gastrointestinal origin.
Pineal metastasis is generally uncommon and incidental event that occurs late in the course of metastatic cancers.