Metastatic Pineoblastoma, Sugarcoating

Patient with a known diagnosis of pineoblastoma status post resection. Routine followup imaging of the spine demonstrate subtle nodularity along the ventral and dorsal surfaces of the thoracic spinal cord on the fluid sensitive images. Postcontrast images demonstrate nodular and more linear regions of enhancement, more than expected for small draining veins. Imaging findings are classic for what is known as sugar coating and reflect findings of leptomeningeal drop metastatic disease or leptomeningeal carcinomatosis. Primary tumors which typically demonstrate drop metastatic disease include glioblastoma, medulloblastoma, PNET, ependymoma, germinoma and choroid plexus carcinoma. The most common secondary tumors demonstrate drop metastatic disease include breast cancer, lung cancer, melanoma and lymphoma. Definitive diagnosis requires lumbar puncture with CSF fluid sampling.