“Somewhere up there”: A case Of pineal gland tumor in a 20-year-old male

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Pineal region tumor is a rare and reportable case. Incidence rate adults is 0.025 in 10,000 hence there is no established guidelines among adults  for diagnosis and management of this case.<br /><strong>CASE:</strong> A case of a 20-year-old male with a two-month history of  intermittent  headache,  occipital  area  with  VAS  5/10,increasing in severity. Until two days prior to admission with severe headache VAS 9-10/10, occipital, and nonradiating.Patient  noted  episodes  of  projectile  vomiting  hence,admitted. Patient presented with non-lateralizing symptoms but  noted  papilledema  and  parinaud  syndrome.Cranial  MRI with contrast revealed a 2.5cm pineal gland tumor with obstructive  hydrocephalus.  Serum  AFP  (alpha-fetoprotein  )  and  beta-HCG  (beta subunit of human chorionic gonadotropin) were requested and revealed elevated levels.The patient underwent endoscopic third ventriculostomy but no biopsy was done due to high risk of bleeding. Patient underwent series of radiotherapy and was advised to undergo chemotherapy but patient refused. Patient had improved upward gaze but with residuals, no recurrence of headache or vomiting, had normalization of the serum tumor markers but noted increase in size of the tumor despite radiotherapy.<br /><strong>CONCLUSION:</strong> Case  reports  of  pineal  region  tumors  will  help doctors  in  the  primary  hospitals  diagnose  such  cases  and differentiate it from benign causes of headache. This will aid in early referral to specialists and early intervention.</p>

"Somewhere up there": A case of pineal gland tumor in a 20-year-old male

BACKGROUND: Pineal region tumor is a rare and reportable case. Incidence rate adults is 0.025 in 10,000 hence there is no established guidelines among adults  for diagnosis and management of this case.CASE: A case of a 20-year-old male with a two-month history of  intermittent  headache,  occipital  area  with  VAS  5/10,increasing in severity. Until two days prior to admission with severe headache VAS 9-10/10, occipital, and nonradiating.Patient  noted  episodes  of  projectile  vomiting  hence,admitted. Patient presented with non-lateralizing symptoms but  noted  papilledema  and  parinaud  syndrome.Cranial  MRI with contrast revealed a 2.5cm pineal gland tumor with obstructive  hydrocephalus.  Serum  AFP  (alpha-fetoprotein  )  and  beta-HCG  (beta subunit of human chorionic gonadotropin) were requested and revealed elevated levels.The patient underwent endoscopic third ventriculostomy but no biopsy was done due to high risk of bleeding. Patient underwent series of radiotherapy and was advised to undergo chemotherapy but patient refused. Patient had improved upward gaze but with residuals, no recurrence of headache or vomiting, had normalization of the serum tumor markers but noted increase in size of the tumor despite radiotherapy.CONCLUSION: Case  reports  of  pineal  region  tumors  will  help doctors  in  the  primary  hospitals  diagnose  such  cases  and differentiate it from benign causes of headache. This will aid in early referral to specialists and early intervention.

"Somewhere up there": A case of pineal gland tumor in a 20-year-old male

BACKGROUND: Pineal region tumor is a rare and reportable case. Incidence rate adults is 0.025 in 10,000 hence there is no established guidelines among adults  for diagnosis and management of this case.CASE: A case of a 20-year-old male with a two-month history of  intermittent  headache,  occipital  area  with  VAS  5/10,increasing in severity. Until two days prior to admission with severe headache VAS 9-10/10, occipital, and nonradiating.Patient  noted  episodes  of  projectile  vomiting  hence,admitted. Patient presented with non-lateralizing symptoms but  noted  papilledema  and  parinaud  syndrome.Cranial  MRI with contrast revealed a 2.5cm pineal gland tumor with obstructive  hydrocephalus.  Serum  AFP  (alpha-fetoprotein  )  and  beta-HCG  (beta subunit of human chorionic gonadotropin) were requested and revealed elevated levels.The patient underwent endoscopic third ventriculostomy but no biopsy was done due to high risk of bleeding. Patient underwent series of radiotherapy and was advised to undergo chemotherapy but patient refused. Patient had improved upward gaze but with residuals, no recurrence of headache or vomiting, had normalization of the serum tumor markers but noted increase in size of the tumor despite radiotherapy.CONCLUSION: Case  reports  of  pineal  region  tumors  will  help doctors  in  the  primary  hospitals  diagnose  such  cases  and differentiate it from benign causes of headache. This will aid in early referral to specialists and early intervention.

Roles of endoscopic biopsy and third ventriculostomy in the diagnosis and treatment of pineal region tumors in children / 第三军医大学学报

Objective To investigate the roles of endoscopic biopsy and third ventriculostomy in the diagnosis and treatment of pineal region tumors in children. Methods Endoscopic biopsy and third ventriculostomy were performed in 9 pediatric patients with pineal region tumors. Results Successful third ventriculostomy, confirmed by MRI, was performed in 9 cases of children with obstructive hydrocephalus. No complications were found in all patients. Conclusion Endoscopic biopsy and third ventriculostomy are effective neuroendoscopic procedures in minimally invasive preferential management of pineal region tumors.

A Study of Therapeutic Modalities of Pineal Region Tumors

The management of pineal region tumors remains controversial. Advocates of a conservative approach emphasize the excellent results of radiotherapy, particularly with germinoma, while a number of recent reports have demonstrated the safety of direct surgery. We analyzed 8 cases of pineal region tumors which had been treated at our institution over the past 7 years. Tissue diagnosis was obtained in 3 patients before irradiation and 5 patients underwent irradiation without histological diagnosis. Among 5 irradiated patients initially, four patients had been achieved complete remission by radiotherapy thus they were presumptively germinoma, but other one patient had no response, so she had been underwent surgery. Among 3 biopsy proven cases, 2 were teratoma and other one was embryonal carcinoma. Complete gross microsurgical excision of well encapsulated tumor was possible in two teratoma cases. MRI and other neuroradiological studies have ben found to be useful in indicating the biological nature and histological type of pineal tumor. So, consideration of MRI scans together with tumor markers and response to small dose irradiation will generally allow a specific diagnosis with a high degree of probability. In this way, germinomas may be selected for radiotherapy and the tumor less likely to response may be subject to primary surgery to obtain complete tumor extirpation or tissue diagnosis.

A Clinical Analysis of 20 Cases of Pineal Region Tumors

A retrospective analysis was made of 20 patients with pineal region tumors who were treated at the Department of Neurosurgery, Capital Armed Forces General Hospital between May of 1987 and March of 1993. We performed ventriculo-peritoneal shunt in 17 patients with obstructive hydrocephalus. Tissue diagnosis was obtained in 7 patients before irradiation and 13 patients underwent irradiation without histological diagnosis. Among 7 biopsy-proven cases, 5 were germinoma, one was mixed germ cell tumor and another one was astrocytoma. The response to irradiation and tumor marker study revealed that 13 patients who did not have tissue diagnosis seemed to be germinomatous, non-germinomatous germ cell tumors and endodermal sinus tumor. So, the following results were obtained. 1) The patients were all young males. 2) The main presenting symptoms and signs were headache, vomiting and papilledema. 3) The tumors were mainly presented as a round well-enhancing masses with calcification. 4) Based on the classification of pineal tumor, germinoma was predominant tumor type. 5) The extrapineal metastasis was found in 5 cases(25.0%). 6) The tumor marker (alpha-FP or HCG) was positive in 5 cases(25.0%). 7) Germinoma showed excellent prognosis after the irradiation.

A Clinical Analysis of 11 Cases of Pineal Region Tumor

The authors analyzed 11 cases of pineal region tumor in young male patients who had been treated at the Capital Armed General Hospital. So, the following results were obtained. 1) Due to the army distinctiveness, all cases were young male patients. 2) An unusual large proportion of pineal region tumor(26.2%) was noted. 3) Headache and vomiting were main presenting symptoms and the duration of symptoms was short. 4) The tumors were mainly presented as a round well-enchancing masses with calcification. Also, nearly all were associated with hydrocephalus. 5) MRI was very useful for the demonstration of tumor extent. 6) Based on the classification of pineal tumor, the tumors of germ cell origin were predominant(81.9%). 7) The extrapineal metastasis was frequent. 8) The tumor marker(alpha-FP and HCG) was postive in 4 cases(36.4%). 9) Germinoma showed excellent prognosis for the irradiation following a drainage procedure.