Clinical Observation on the Pineal Tumors

ABSTRACT

Tumors of the pineal area are a small proportion of neoplasm of the brain and the majority of these tumor are pathologically classified as pinealoma, Until recently, ventriculography was the most useful diagnostic methods in suspected cases of pineal tumor. However, the diagnosis of posterior third ventricular tumor may be established easily with computed tomography(CT) and its size, shape, component of tumor and the direction of expansion may be visualized. Authors had experienced nine cases of the pineal tumor during about two years from October 1977 to July 1979, which were diagnosed with CT, EMI-5005 in type. We presented a clinical findings for our cases and attempted to assess clinically. The result were summarized as following; 1. The age range was from 5 months after birth to 39 years. Of 9 cases, 6 cases were below age of 20 years and 3 over age of 20 years. All but one were found in males. 2. The duration of symptoms varied from two weeks to eighteen months. The average was approximately 7 months. 3. The symptoms and signs depend on the route taken by the expanding tumors. In our series, headache found in all cases initially, vomiting in 7 cases, and papilledema in 7 cases on admission. Parinaud's sign showed in 5 cases of all patients and papillary change in 3 cases. Of 9 cases, 3 cases had a transient DI symptoms and 2 cases manifested cerebellar dysfunction in corresponding to CT findings. 4. We had performed CT scan on all cases and diagnosed pineal tumor. In pre-enhancement CT, increased density around pineal area showed in 5 cases, isodensity in 2 cases and low density in 2 cases. Among the 9 cases, 5 cases, showed well outlined a lesion by contrast enhancement. All of the cases showed symmetrical dilatation of lateral ventricles with variable degree and distortion and compression defect to the posterior third ventricle disclosed in 6 cases. 5. We had treated 8 cases with V-P shunt following irradiation therapy ranged 3000-600 Rad. in total amount for 5-6 weeks. A case of the pineal tumor had treated with V-P shunt alone because of full coma at admission. We performed biopsy through the infratentorial supracerebellar approach in one case only and confirmed pineocytoma histopathologically. 6. The result of treatment obtained as follows with excellent in 3 cases, good in 4, poor in one, and death in one case. Two cases with exellent result of treatment spend their life happily without any symptoms and follow up CT disclosed no evidence of previous tumor shadow and normal sized ventricles. A poor case developed quadriplegia during irradiation therapy due to tumor seeding to cervical cord probably.