Pineal gland invasion and leptomeningeal dissemination of pancreatic mucinous adenocarcinoma

Tumors that metastasize to the central nervous system rarely invade the pineal region. Many reports suggest that metastasis to the pineal region occurs as a solitary event. Here, we present the first case of mucinous adenocarcinoma of the pancreas metastasizing to the pineal gland. Autopsy of this 90-year-old man revealed leptomeningeal involvement and multiple intracranial metastatic lesions, including the fourth ventricle and the cerebellum, in addition to the pineal gland. These lesions may have contributed to his symptoms of falling and insomnia, agitation, and aggressive behaviors during the several months prior to his metastatic pancreatic cancer diagnosis and death. We also review the primary sites and other intracranial metastasis sites in 279 reported cases of pineal region metastases, and highlight the possibility of multiple intracranial lesions in patients with pineal gland metastasis.