primary Glioblastoma Multiforme in the pineal region: a case report with diagnostic imaging findings, treatment response, and literature review

Reprint requests to: Dr. I-Hao Su Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital. No. 5, Fu Hsing Street, Gueishan, Taoyuan 33333, Taiwan, R.O.C. Glioblastoma multiforme (GBM) is one of the most common primary tumors of the central nervous system, comprising up to half of al l primary brain tumors; however, primary GBM of the pineal region is extremely rare. To our knowledge, there are only 18 reported cases. We report a rare case of pineal GBM in a 32-year-old male who presented with headache, visual image distortion, and vertigo. Computed tomography, magnetic resonance imaging, and cerebral angiography revealed a tumor mass in the pineal region. The mass was diagnosed as a glioblastoma following subtotal removal. After combined surgery and concurrent chemoradiotherapy treatment, our patient survived longer than 1 year after the initial diagnosis. Here, we present the radiographic features and treatment strategy of pineal GBM, with a review of the literature. The pineal reg ion is def ined as the space del imitated super iorly by the splen ium of the corpus callosum and the choroid plexus of the third ventricle, anteriorly by the third ventricle, anteroinferiorly by the lamina quadrigemina, inferiorly by the anterior face of the cerebellum culmen, and laterally by the thalami and medial faces of the cerebral hemispheres [1]. It consists of the pineal body, the posterior wall of the third ventricle, tela choroidea, and velum interpositum. Thus, a tumor in the pineal region could have originated from the pineal gland itself, the posterior portion of the third ventricle, or the quadrigemina cistern [1, 2]. Although glioblastoma multiforme (GBM) is one of the most common pr imary tumors of the cent ral nervous system, comprising up to half of all primary brain tumors [3, 4], primary GBM of the pineal region is extremely rare, with only 18 reported cases [1, 2, 5-15]. We repor t a ra re case of pineal GBM in a 32-year-old male, compare the f indings in this patient with those in the literature in terms of clinical and radiological characteristics and angiographic findings, and discuss the treatment response.