Germinoma pineal y supraselar sincrónico: a propósito de un caso / Simultaneous suprasellar and pineal germinoma: a case report

Los tumores de la región pineal son poco frecuentes (0,3-2,7%) y la mayoría corresponde a tumoresde células germinales; de éstos, el germinoma es el más frecuente. Se localizan principalmente en la glándula pineal, y le siguen en frecuencia la región supraselar y el cuarto ventrículo, pero la presentación sincrónica en estas localizaciones es relativamentepoco frecuente (5-10% de los casos). El objetivo principal de este estudio consiste en revisar el diagnóstico diferencial de las neoplasias de la región pineal. Caso clínico. Varón de 20 años de edad que ingresa por alteración del campo visual,con clínica de panhipopituitarismo y marcadores tumorales en sangre y líquido cefalorraquídeo normales. Se le realizó resonancia magnética del eje craneoespinal y se evidenció la presencia de dos masas con significativo realce, una de localizaciónpineal con señal similar a la sustancia gris, y otra en el hipotálamo, de aspecto más heterogéneo, con áreas quísticas en el interior.Con contraste paramagnético se demostró diseminación con captación ependimaria en relación con las astas frontalesy en el cuarto ventrículo, localización esta última en la que se plantea también un posible origen sincrónico. Conclusiones. La resonancia magnética desempeña un papel determinante en el establecimiento de su diagnóstico y plan terapéutico. Los factoresque deben considerarse son el origen de la masa, la heterogeneidad, el realce de contraste, la presencia de grasa o calcio, la señal similar a la sustancia gris y la posible diseminación, sobre todo al espacio subaracnoideo. También debe tenerse encuenta la historia clínica (edad, sexo o marcadores tumorales)

Tumours in the pineal region are rare (0.3-2.7%) and most of the ones that do occur are germ celltumours, of which germinoma is the most frequent. They are chiefly located in the pineal gland, the next most common being site being the suprasellar region and the fourth ventricle, although simultaneous presentation in these locations is relatively rare (5-10% of cases). The main aim of this study is to review the differential diagnosis of neoplasias in the pineal region. Casereport. Here we report the case of a 20-year-old male who was admitted to hospital due to irregularities affecting the field of vision, with clinical signs and symptoms of panhypopituitarism and normal levels of tumour markers in blood and cerebrospinalfluid. Magnetic resonance imaging of the craniospinal axis was performed and results showed the presence of twomasses with significant enhancement, one located in the pineal region with a signal similar to that of grey matter and the other in the hypothalamus, which had a more heterogeneous aspect with cystic areas inside it. Imaging with paramagnetic contrastagents revealed dissemination with ependymal uptake in relation to the frontal horns and in the fourth ventricle; a possible simultaneous origin was also suggested in this latter location. Conclusions. Magnetic resonance imaging plays a decisive rolein establishing the diagnosis and therapy plan. The imaging factors that must be taken into account are the origin of the mass, heterogeneity, contrast enhancement, presence of fat or calcium, a signal similar to that of grey matter and possible dissemination, above all into the subarachnoid space. The patient’s medical record (age, sex or tumour markers) must also betaken into consideration

[Olanzapine and cognitive-behavioural group therapy in borderline personality disorder]. / Olanzapina y terapia grupal cognitivo-conductual en trastorno límite de la personalidad.

INTRODUCTION: Borderline Personality Disorder (BPD) is considered one of the most difficult psychiatric conditions to treat, neither psychological nor pharmacological treatments have been shown to be particularly effective. We present a proposal for the treatment of patients diagnosed with BPD which uses an atypical neuroleptic, olanzapine, and cognitive-behavioural group therapy aimed at dealing with the following problems: Interpersonal Conflict, Affective Instability, Impulsiveness, and Confused Identity. METHODS: Six patients diagnosed with BPD using the International Personality Disorder Evaluation (IPDE) were treated during 6 months with olanzapine (at dosages of 5-20mg/day) and dialectical behaviour therapy, with weekly 2-hour sessions. RESULTS: All of these patients followed the programme during the first 2 months, and 3 of the 6 completed it, showing an improvement in their behavioural disorder, as indicated by a decrease in parasuicidal episodes (i.e. suicide attempts and self-mutilative acts) and fewer visits to the emergency department. One of the patients dropped out due to side effects. DISCUSSION: The possibility of using a combined therapeutic approach enables us to project controlled clinical trials over a longer period of time, thus making it possible to assess behavioural changes which are difficult to observe in conventional clinical trials.