The present report concerns a six years nine months old boy in whom a HCG secreting pineal tumor (pinealocytoma type I) was responsible for precocious puberty. Features : polydipsia, deepened voice, pubic hair, penile enlargement without corresponding testicular growth. Serum basal concentrations of LH (150 mU/ml), testosterone (85.80 nanomole/l), HCG (115 ng/ml) and its beta subunit (15 ng/ml) were markedly elevated, FSH was low (3.9 mU/ml) ] dissociated hypopituitarism was also present. A surgical removal of the tumor was performed (RIA of the neoplastic tissue revealed high HCG and beta HCG activity) and after the operation the child had radiation therapy. Recovery for the foregoing procedure was rapid, but after some months, in spite chemotherapy his condition deteriorated progressively. The apparent limitation of pinealoma and precocious puberty to the male sex is discussed and supposed to be partly the result of the ectopic gonadotropin secretion. These tumors are compared to other HCG secreting carcinomas located elsewhere in the body and causing sexual precocity in boys only.
Durko, Marcin; Jankowski, Andrzej; Durko, Tomasz; Gajewicz, Witold; Pajor, Anna
Acoustic neuroma usually presents as an unilateral tumor, seldom - bilateral and rarely in coexistence with other central nervous system neoplasms. The following paper reports such a case of a 21-year-old male patient presented with sudden deafness in left ear accompanied with tinnitus and vertigo. Symptoms started 4 weeks prior hospitalization. Their aggravation has been observed 7 days before admission to the hospital. Audiometry revealed moderate sensorineural hearing loss in left ear (for low and middle frequencies), brainstem auditory evoked potentials were absent on the left side and ENG examination showed left peripheral vestibular impairment. Initially patient received i.v. vasodilatators showing 20-25 dB improvement in low frequencies after 3 days of treatment. MRI study revealed in the left internal acoustic meatus mass (7 x 7 x 14 mm) suggesting acoustic neuroma and an oval mass (7 x 9 x 14 mm) in the pineal gland presenting radiological features of pinealoma. Patient has been qualified for neurosurgical treatment. Acoustic neuroma has been removed by suboccipital approach and pinealoma has been left for further observation as it was found incidentally. Histopathological examination confirmed diagnosis of left VIII nerve schwannoma. The left facial palsy (House-Brackmann III/IV grade) and profound hearing loss appeared after surgery. The postoperative course shows no evidence of acoustic neuroma recurrence.
Treumann, Silke; Buesen, Roland; Gröters, Sibylle; Eichler, Jens-Olaf; van Ravenzwaay, Bennard
Pineal gland tumors are very rare brain lesions in rats as well as in other species including humans. A total of 8 (out of 1,360 examined) Wistar rats from 3 different combined chronic toxicity/carcinogenicity or mere carcinogenicity studies revealed pineal gland tumors. The tumors were regarded to be spontaneous and unrelated to treatment. The morphology and immunohistochemical evaluation led to the diagnosis malignant pinealoma. The main characteristics that were variably developed within the tumors were the following: cellular atypia, high mitotic index, giant cells, necrosis, Homer Wright rosettes, Flexner-Wintersteiner rosettes and pseudorosettes, positive immunohistochemical reaction for synaptophysin, and neuron-specific enolase. The pineal gland is not a protocol organ for histopathological examination in carcinogenicity studies. Nevertheless, the pineal gland can occasionally be encountered on the routine brain section or if it is the origin of a tumor protruding into the brain, the finding will be recorded. Therefore, although known to be a rare tumor in rats, pineal neoplasms should be included in the list of possible differential diagnoses for brain tumors, especially when the tumor is located in the region of the pineal body.
LAN Qing; DONG Jun; HUANG Qiang
Background In recent years, keyhole microsurgery has become an important subject of modem minimally invasive neurosurgery. In this study, minimally invasive techniques avoiding unnecessary tissue injuries were applied to refine traditional approaches for the removal of third ventricular tumors within a limited operative filed.Methods Individualized keyhole approaches were designed according to the characteristics of third ventricular tumors and their growth patterns. A series of keyhole approaches such as supraorbital subfrontal approach,infratentorial supracerebellar approach, interhemispheric transcallosal approach, pterional approach were taken to enter the third ventricle anteriorly, posteriorly, superiorly or laterally, respectively. A total of 34 removed tumors in or extended into the third ventricle included 11 craniopharyngiomas, 10 pituitary adenomas, 2 pinealomas, 1cholesteatoma, 3 germinomas, and 7 gliomas.Results Total tumor resection was done in 27 (79.4%) of the patients, and subtotal resection in 7 patients (20.6%). Residual tumor was due to tight adherence of germinoma to the vein of Galen (1 patient),craniopharyngioma to the pituitary stalk (3), supratentorial extension of pineal region gliomas (1), suprasellar extension of gliomas (1) and giant pituitary adenoma (1). Complications such as brain contusion, postoperative hemorrhage and infection were not associated with keyhole approaches. Extended incision or enlarged bone flap was not made because of episode during operation or inadequate exposure.Conclusions Keyhole approaches are safe, effective and minimally invasive in the surgical treatment of tumors deeply seated in the third ventricle. Individualized keyhole approach ensures a successful treatment. Tumors in the upper middle part of the third ventricle can be exposed by the interhemispheric transcallosal keyhole approach. Tumors of the posterior third ventricle may be well exposed by the infratentorial supracerebellar keyhole approach