Asia Oceania Journal of Nuclear Medicine and Biology

Asia Oceania Journal of Nuclear Medicine and Biology

Utility of 18F-FDG PET/CT in Detecting Spinal Drop Metastases from Pineal Gland Tumors

Document Type : Case report

Authors
Kabilash Dhayalan
Harish Goyal
Pradap Palanivelu
Dhanapathi Halanaik
Department of Nuclear Medicine Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
10.22038/aojnmb.2024.74259.1518
Abstract
Pineal gland tumors are significant despite being rare (<1%) among all brain tumors. Germ cell tumors are the most common among the pineal gland tumors. Often affecting young adults, pineal gland germ cell tumors are hard to diagnose due to different symptoms and potential spread. But they rarely show leptomeningeal spread and extracranial metastases. Other differentials include primary tumors of the pineal region, Pineal gliomas, and metastases. The leptomeningeal spread of these tumors has not been studied so far. Conventional radiological imaging modalities are routinely used to diagnose and evaluate these tumors. We report a case here showing a pineal gland tumor with leptomeningeal spread detected by 18F-FDG PET/CT. Our case shows how pineal gland tumors can behave unusually and how 18F-FDG PET/CT can be crucial for accurately assessing the extent of the disease in the body to provide effective treatment. This case report illustrates the rare type of spread of pineal gland tumor and how 18F-FDG PET/CT helps detect this rare type of metastasis, thereby helping in prognostication and deciding further treatment of the patient.
Keywords
Pineal gland
Spinal drops metastases
18F-FDG PET/CT
Germ cell tumors
Subjects
  1. Favero G, Bonomini F, Rezzani R. Pineal Gland Tumors: A Review. Cancers (Basel). 2021; 13(7): 1547.
  2. Gaillard F, Jones J. Masses of the pineal region: clinical presentation and radio-graphic features. Postgrad Med J. 2010; 86(1020): 597-607.
  3. Chang T, Teng MM, Guo WY, Sheng WC. CT of pineal tumors and intracranial germ-cell tumors. AJR Am J Roentgenol. 1989; 153(6): 1269-74.
  4. Vasiljevic A, Szathmari A, Champier J, Fèvre-Montange M, Jouvet A. Histo-pathology of pineal germ cell tumors. Neurochirurgie. 2015; 61(2-3): 130-7.
  5. Al-Hussaini M, Sultan I, Abuirmileh N, Jaradat I, Qaddoumi I. Pineal gland tumors: experience from the SEER database. J Neurooncol. 2009; 94(3): 351-8.
  6. Sibanda Z, Farahani N, Ogbonnaya E, Albanese E. Glioblastoma multiforme: A rare case of spinal drop metastasis. World Neurosurg. 2020; 144: 24-27.
  7. Chandra P, Purandare N, Shah S, et al. “Drop” metastases from an operated case of intracranial anaplastic ependymoma identified on Fluoro-2-deoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med IJNM of J Soc Nucl Med India. 2017; 32(1): 68-70.
  8. Jain TK, Basher RK, Sood A, Mittal BR, Prakash G, Bhatia A. 18F-FDG PET/CT finding of drop metastases from germ cell tumor of pineal gland. J Nucl Med Technol. 2017; 45(2):114-115.
  9. Murray MJ, Bartels U, Nishikawa R, Fangusaro J, Matsutani M, Nicholson JC. Consensus on the management of intracranial germ-cell tumours. Lancet Oncol. 2015; 16(9):e470-e477.
  10. Ogawa K, Yoshii Y, Shikama N, Nakamura K, Uno T, Onishi H, et al. Spinal recurrence from intracranial germinoma: risk factors and treatment outcome for spinal recurrence. Int J Radiat Oncol Biol Phys. 2008; 72(5):1347-54.
  11. Kralik SF, O'Neill DP, Kamer AP, Rodriguez E, Ho CY. Radiological diagnosis of drop metastases from paediatric brain tumours using combination of 2D and 3D MRI sequences. Clin Radiol. 2017; 72(10): 902.e13-902.e19.
  12. Solomou AG. Magnetic resonance imaging of pineal tumors and drop metastases: a review approach. Rare Tumors. 2017; 9(3): 6715.
  13. Sharma P, Jain TK, Parida GK, Karunanithi S, Patel C, Sharma A, et al. Diagnostic accuracy of integrated (18)F-FDG PET/CT for restaging patients with malignant germ cell tumours. Br J Radiol. 2014; 87(1040): 20140263.
  14. Saini VK, Ora M. Extensive drop metastases from pineal gland tumor: A case report. Clin Nucl Med. 2023; 48(1): e35-e36.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 12, Issue 2
July 2024
Pages 170-173