Multimodal treatment of pineal metastasis from oesophageal adenocarcinoma

Abstract

The pineal gland is a neuroendocrine gland located in the epithalamus. Primary pineal tumours are uncommon and metastatic cancer spreading to the pineal gland is even more unusual. Brain metastases from adenocarcinoma of upper gastrointestinal tract occur in less than 1.5% of patients, yet no clear data about the incidence of metastases in the pineal region are available. This study presents the case of a 73-year-old man who presented to the emergency room with neurological symptoms. MRI revealed a pathological lesion in the pineal gland with histological findings of metastasis from adenocarcinoma of gastrointestinal origin. An oesophagogastroduodenoscopy was performed and a distal lesion was found, which was biopsied and histologically defined as oesophageal adenocarcinoma. A literature search identified six articles regarding pineal metastases from oesophageal carcinoma. Our clinical case was compared to the literature cases examining, in particular, nine parameters of analysis: age, sex, histological diagnosis, timing of metastatic pineal onset, overall metastatic sites, clinical presentation, imaging features, size and specific treatment for the pineal lesion. Despite the small sample and ‘niche’ topic in the medical literature, some important conclusions can be drawn: pineal metastases are rare, their origin is difficult to define, they require multidisciplinary management, and they can produce neurological symptoms; consequently, they must be treated through a welltimed locoregional approach (surgical or radiotherapy). Finally, further scientific research is needed to better understand the pathological mechanisms of malignant cellular homing at the pineal level.