Lung carcinoma metastasis presenting as a pineal region tumor

the pineal region is an unusual site for brain metastasis and most metastatic pineal lesions are asymptomatic. a 53 year-old man presented with severe headache, limitation of upward gaze and diplopia. the patient's neurological examination was unremarkable. magnetic resonance imaging (mri) scans of the brain demonstrated a 1,5 x 2 cm well demarcated solitary mass in the pineal region with hydrocephalus. surgery was performed and adenocarcinoma was diagnosed. a systemic investigation revealed adenocarcinoma of the lung as primary lesion. although rare, metastatic tumor should be considered in the differential diagnosis of pineal region tumors.