title: Primary pineal malignant melanoma - illustrated review.
abstract: OBJECTIVE
  Primary pineal melanoma is a rare tumor. We herein review the histogenesis, pathology, radiology and therapeutic options of this rare tumor.
  
  
  METHODS
  We conducted a PUBMED search using a combination of keywords such as "primary pineal melanoma", "CNS melanoma", and "pineal tumor" and identified 16 cases of primary pineal melanoma. Clinical features, pathologic characteristics and treatment details of these patients were noted from respective case reports. We also describe a case of a 45-year-old Indian woman with primary pineal melanoma treated with a combination of surgery and post-op radiation.
  
  
  RESULTS
  The median age at presentation is 50 years. Median duration of symptoms is 6 weeks. Common symptoms at presentation include headache (58.8%), personality changes (41.2%), gait disturbance (35.3%) and Parinaud's syndrome (29.4%). Surgery, radiotherapy and chemotherapy have been used in 29.4%, 47.1% and 23.5% of patients respectively. Median overall survival is 56 weeks. Leptomeningeal dissemination and ventricular ependymal spread were noted in 70.6% and 35.3% patients, respectively.
  
  
  CONCLUSIONS
  Combined modality treatment comprising maximal safe surgery and post-operative radiation should be preferred in patients with localized pineal melanoma without leptomeningeal dissemination. Taking a cue from other subsites of melanoma, chemotherapy can perhaps be deferred until recurrence.
authors.affiliation: All India Institute of Medical Sciences, Departments of Radiotherapy and Oncology, New Delhi, India.
authors.forename: Ahitagni
authors.initials: A
authors.lastname: Biswas
authors.forename: Pritee B
authors.initials: PB
authors.lastname: Chaudhari
authors.forename: Sujith Kumar
authors.initials: SK
authors.lastname: M
authors.forename: Elanthenral
authors.initials: E
authors.lastname: Sigamani
authors.forename: Meher Chand
authors.initials: MC
authors.lastname: Sharma
authors.forename: Samir Kumar
authors.initials: SK
authors.lastname: Kalra
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Julka
authors.forename: Goura Kishor
authors.initials: GK
authors.lastname: Rath
mesh_terms: D005260:Female; D006801:Humans; D008545:Melanoma / Q000473:pathology* / Q000628:therapy*; D008875:Middle Aged; D010871:Pinealoma / Q000473:pathology* / Q000628:therapy*