Glioblastoma Multiforme in the Pineal Region with Leptomeningeal Dissemination and Lumbar Metastasis

brain showed heterogeneous enhancement in the pineal region without pituitary tumor and leptomeningeal and ventricular dissemination (Fig. 1).Blood examination showed normal serum levels of α-fetoprotein, β human chronic gonadotrophin and placental alkaline phosphatase.Cerebral angiography revealed a vascular rich tumor fed by the posterior choroidal artery and arterial-venous shunting.In order to confirm the pathological diagnosis and remove the tumor, she underwent subtotal resection of the pineal tumor with craniotomy using the occipital transtentorial approach.In the intraoperative findings, the tumor was soft and bled easily.It was easy to dissect the tumor from the splenium.We concluded that the tumor originated in the pineal region, not in the splenium or midbrain.Finally, we performed subtotal resection because it was very difficult to stop the bleeding in the left superior and lateral parts of the tumor.She exhibited no new neurological deficits after the surgical resection.Histopathological findings showed the feature of glioblastoma composed of poorly differentiated pleomorphic tumor cells with marked nuclear atypia and brisk mitotic activity (Fig. 2).Focal necrosis with pseudopalisading was found, and MIB-1 proliferation index was high (43.7%).Immunohistochemistry showed a positive reaction to the glial fibrillary acidic protein, S-100, nestin, and INI-1.On the other hand, it showed a negative reaction