ABSTRACT
BACKGROUND: The case of a 29-year-old man with histologically proven simultaneous germinoma (seminoma) of the pineal gland and a stage I embryonal carcinoma of the testis is reported. An intradural metastatic lesion from the pineal germinoma was diagnosed at the level of the first thoracic vertebra. Treatment, after inguinal orchiectomy, was chemotherapy only, rather than conventional radiotherapy for the pineal germinoma. METHODS: Therapy consisted of bleomycin (B), etoposide (E) and cisplatin (P). MRI was used to assess the effectiveness of BEP chemotherapy. RESULTS: A complete remission of the pineal gland germinoma and the epidural metastasis was documented after two cycles of BEP chemotherapy and after 15 months of follow-up the patient remains free of relapse. DISCUSSION: The pathogenesis of simultaneously occurring germinoma of the pineal gland and embryonal cell carcinoma of the testis is discussed. The choice of therapy in these circumstances is a matter of debate and the good result of chemotherapy alone in this patient suggest that primary chemotherapy may be the therapy of choice in patients with pineal germinomas.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Brain Neoplasms/drug therapy , Carcinoma, Embryonal/drug therapy , Neoplasms, Multiple Primary/drug therapy , Pineal Gland , Pinealoma/drug therapy , Testicular Neoplasms/drug therapy , Adult , Bleomycin/administration & dosage , Brain Neoplasms/pathology , Carcinoma, Embryonal/pathology , Cisplatin/administration & dosage , Etoposide/administration & dosage , Humans , Male , Neoplasms, Multiple Primary/pathology , Pinealoma/pathology , Testicular Neoplasms/pathology , Treatment OutcomeABSTRACT
The prognosis of patients subjected to operation for a solitary cerebral metastasis from a pulmonary carcinoma is unfavourable. The prognosis of a solitary cerebral metastasis from a mammary carcinoma that is removed appears to be better: a prolongation of life of acceptable duration and quality is frequently achieved.
Subject(s)
Brain Neoplasms/secondary , Breast Neoplasms , Lung Neoplasms , Adult , Aged , Brain Neoplasms/mortality , Brain Neoplasms/surgery , Female , Humans , Male , Middle Aged , Retrospective Studies , Time FactorsSubject(s)
Hematoma, Epidural, Cranial/diagnostic imaging , Hematoma, Subdural/diagnostic imaging , Spinal Cord Diseases/etiology , Aged , Female , Hematoma, Epidural, Cranial/complications , Hematoma, Epidural, Cranial/surgery , Hematoma, Subdural/complications , Hematoma, Subdural/surgery , Humans , Male , Middle Aged , Paraplegia/etiology , Prognosis , Radiography , Spinal Cord Diseases/surgeryABSTRACT
This retrospective study from two hospitals is about a hundred patients who have been operated upon a spontaneous cerebral hematoma. By a spontaneous cerebral hematoma we mean a hematoma without a proven tumor, without aneurysm, without arteriovenous malformation, without preceding trauma, without aortical phlebitis and without pathology of the vessel-wall. In this study patients with coagulopathy, arterial hypertension and artherosclerosis are included. In order to comply with these conditions an angiography will have to take place pre-operatively as well as postoperatively. Moreover histological examination of the wall of the hematoma will have to be done. The etiology of the spontaneous cerebral hematoma is not clear in most cases. The indication to operate, the way of operating and the moment in which the operation takes place, vary strongly in medical literature. We operate when there is an aggravation of the clinical picture, persisting severe headache and neurological paresis which does not improve. As a rule we abide for one week before operating, if the clinical picture allows this. After the operation unconscious patients may recover and a hemiparesis may improve. The best way of diagnosing a cerebral hematoma is computerised tomography.
Subject(s)
Cerebral Hemorrhage/surgery , Hematoma/surgery , Adult , Cerebral Hemorrhage/diagnostic imaging , Female , Hematoma/diagnostic imaging , Humans , Male , Radiography , Retrospective StudiesSubject(s)
Epilepsy, Post-Traumatic/etiology , Skull Fractures/complications , Amnesia/etiology , Child , Dura Mater/injuries , Humans , Male , RuptureABSTRACT
Loss of cerebrospinal fluid through the nose is known complication of cranial fronto-basilar traumata. Such a fistula generally appears immediately or some time after the trauma; in some cases however the fistula appears a few months or years after. One of the causes of delayed fistula is the existence of leptomeningeal cyst. The clinical symptom of this fistula is often a meningitis. Detection of the fistula is performed through scinticisternography with radioactive media: in case of a leptomeningeal cyst there is a concentration of radioactivity in the fromto-basilar region. In a patient with meningitis and a known history of cranial trauma, even if the latter occurred many years before, it is wise to search for a possible cerbrospinal fluid fistula.
Subject(s)
Cerebrospinal Fluid Rhinorrhea/etiology , Craniocerebral Trauma/complications , Adolescent , Adult , Child , Child, Preschool , Female , Fistula/diagnosis , Fistula/etiology , Humans , Male , Meningitis/etiology , Middle Aged , Radionuclide ImagingABSTRACT
The scintigraphic diagnosis of eight convexity leptomeningeal cysts is described; the cysts appear as a local collection of abnormal radioactivity, best seen at 48 hours. The correlation of the scintigraphic findings with clinical, radiological, and operative findings is discussed.
