We identified 10 patients with symptomatic metastases to the pineal gland. We present the clinical and radiographic findings in this syndrome. Leptomeningeal metastases occur frequently and are a poor prognostic factor. In all cases, the primary cancer was clinically silent, either in remission (six cases) or previously undiagnosed (four cases). Hence, metastatic disease, albeit uncommon, should be considered in the differential diagnosis of pineal tumors.
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