<p>Adult pineoblastoma is an uncommon malignant neoplasm. Relevant literature, particularly regarding its recurrence, is limited; to date, only eight cases of recurrent adult pineoblastoma with detailed treatment information have been reported. Therefore, the optimal treatment for recurrent adult pineoblastoma remains unclear. Here, we report the case of a 58-year-old man with a treatment history of pineal and disseminated pineoblastoma. The patient initially underwent an endoscopic biopsy and was histologically diagnosed with pineoblastoma. He then underwent adjuvant chemotherapy with ifosfamide, cisplatin, and etoposide, followed by radiotherapy, and remained relapse-free for four years. Subsequently, a recurrent spinal lesion was identified at the C2–3 level, and the patient was treated with eight cycles of ifosfamide, cisplatin, and etoposide. However, the lesion continued to grow, and the patient developed symptoms of gait instability. A second biopsy was performed and the patient was histologically diagnosed with pineoblastoma recurrence. The patient underwent local re-irradiation with bevacizumab, achieving a complete response with tumor regression. The patient remained recurrence-free at the 12-month follow-up visit after the second biopsy. These findings suggest that the combination of re-irradiation and bevacizumab may provide an effective therapeutic option for recurrent histological pineoblastoma in adults.</p>