&NA;A case of metastatic small cell carcinoma to the pineal body is reported and the clinical and radiological features of this rare tumor are discussed. A 66‐year‐old man presented with progressive dementia, gait disturbance, vertical gaze palsy. and convergence retraction nystagmus. Computed tomographic scan revealed a 2 × 3‐cm high‐density mass in the pineal region, which showed strong contrast enhancement. The tumor was resected through a right occipital transtentorial approach. The pathological diagnosis of the surgical specimens was small cell carcinoma. A systemic workup for the primary lesion subsequently revealed small cell carcinoma of the lung. Although occurring rarely, metastatic tumor should be considered in the differential diagnosis of pineal tumor in elderly patients. (Neurosurgery25:810‐813, 1989)