Remission, recurrence, and metastasis of pineal parenchymal tumor of intermediate differentiation

Sagittal contrast-enhanced T1-weighted MRI of the brain (A-C) shows a solid, enhancing pineal tumor (arrow) at the time of presentation (A) and during remission 6 years later (B). Ten years after presentation, the pineal tumor recurs (C, arrowhead). At the time of recurrence, sagittal contrast-enhanced T1-weighted MRI of the spine (D, E) shows multiple areas of abnormal nodular enhancement (dashed arrows), consistent with intramedullary and/or leptomeningeal metastases.