Pearls and oy-sters: Primary pineal melanoma with leptomeningeal carcinomatosis - Supplemental figures

Pearls: Pineal masses commonly present with Parinaud syndrome, a triad consisting of upgaze restriction, convergenceretraction nystagmus, and pupillary light-near dissociation from compression of the quadrigeminal plate. The differential diagnosis for pineal region tumors includes germ cell tumors, pineal parenchymal tumors, glioma, atypical teratoid rhabdoid tumor and metastatic disease. While exceedingly uncommon, primary pineal melanoma is also a known histopathologic entity that is suspected to arise from melanocytes in the pia mater of the pineal gland. Primary pineal melanoma is often treated with surgical resection, radiation, and either chemotherapy or immunotherapy. Some patients have received targeted therapy (such as vemurafenib in patients with BRAF V600E mutation) with varying degrees of success. Oy-sters: Cerebrospinal fluid (CSF) sampling can assist in the diagnosis of pineal tumor, specifically to test for germ cell tumor markers (alphafetoprotein, b...