title: Primary malignant melanoma in the pineal region treated without chemotherapy.
abstract: BACKGROUND
  Primary pineal malignant melanomas are uncommon intracranial tumor. Here we discuss and review a case of primary pineal malignant melanoma over its feature of imaging studies, pathological findings, and management.
  
  
  METHODS
  A 49-year-old woman receiving renal dialysis underwent computed tomography due to a 4-month history of tinnitus and hearing disturbance. A high-density 35-mm diameter tumor was detected in the pineal region; there was obstructive hydrocephalus. The tumor was heterogeneously hyperintense on T1-weighted magnetic resonance images, iso- and low-mixed intense on T2-weighted images with hemorrhagic components, and very low-intense on T2(*) images. A tumor was subtotally removed via the occipital transtentorial approach. Histologically, it consisted of densely proliferated spindle-shaped or polygonal cells with rich cytoplasmic melanin. The neoplastic cells manifested cellular pleomorphism, nuclear atypia, and mitosis (3/10 high-power fields) and were immunopositive for HMB45, Melan-A, and S100 protein. The MIB-1 index was 17.4%. Whole-body 18-fluoro-deoxyglucose positron emission tomography did not demonstrate any sites with hyper uptake. Examination of the skin and mucosa identified no lesions suggestive of melanoma. She underwent treatment with the whole brain and extended local boost irradiation. Chemotherapy was not delivered due to renal failure. Follow-up imaging studies showed no recurrence or distant lesions 56 weeks after surgery.
  
  
  CONCLUSIONS
  We report a rare case of primary pineal malignant melanoma with prolonged survival of more than 56 weeks after subtotal tumor resection followed by whole-brain and extended local irradiation without chemotherapy. Radiotherapy without chemotherapy might be sufficient for the treatment of this tumor.
authors.affiliation: Department of Neurosurgery, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Shinsato
authors.forename: Tomoko
authors.initials: T
authors.lastname: Hanada
authors.forename: Takao
authors.initials: T
authors.lastname: Kisanuki
authors.forename: Hajime
authors.initials: H
authors.lastname: Yonezawa
authors.forename: Shunji
authors.initials: S
authors.lastname: Yunoue
authors.forename: Takako
authors.initials: T
authors.lastname: Yoshioka
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Hanaya
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tokimura
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Hirano
authors.forename: Kazunori
authors.initials: K
authors.lastname: Arita