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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Recurrent intracranial germinoma with multiple spinal metastases occurred in a 16-year-old male presenting with persistent headache and visual disturbances. Computed tomography revealed enhanced lesions in the pineal region, anterior horn, and infundibulum. Conventional irradiation achieved remission, but local recurrences requiring further irradiation occurred after 23 months. Magnetic resonance imaging showed multiple spinal metastases 11 months later. Partial removal of the spinal lesions gave a histological diagnosis of typical germinoma. Postoperatively, intracranial recurrences were again detected. Chemotherapy consisting of intravenous cisplatin and etoposide achieved remission and no recurrence has occurred for 12 months.
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PMID:Recurrent intracranial germinoma refractory to conventional irradiation: effective chemotherapy consisting of cisplatin and etoposide--case report. 138 Oct 62

Two cases of patients with recurrent brain tumor are presented. Each of them received growth hormone (GH) replacement therapy for growth failure secondary to cranial irradiation. The first case is that of a 10-year-old girl who was treated with a combination of surgical resection, radiotherapy and chemotherapy for cerebellar medulloblastoma at 1 y.o. At the age of 9, 10 month after the beginning of GH replacement therapy, she complained of headache. This was due to shunt malfunction when CSF cytology was class V. It revealed that there was recurrence of medulloblastoma. The second case is that of a 14-year-old girl who was treated with a combination of surgical resection, radiotherapy and chemotherapy for suprasellar germinoma at the age of 10. This tumor completely disappeared after these procedures. For her growth failure, we started GH replacement therapy and after 1 year, she complained of lt. leg pain due to tibial and pelvic bone metastasis. In medical literature, we found 15 recurrent brain tumors during GH replacement therapy. These include our 2 cases, and 9 cases in which there was recurrence within 1 year. Recently, receptors for some somatomedins have been found in brain tumors. Although these numbers are too small for us to arrive at conclusions, we think it is possible that there are some mechanisms connecting GH replacement therapy and recurrence of certain brain tumors.
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PMID:[Two cases of recurrent brain tumor during GH replacement therapy]. 140 52

The occurrence sites of intracranial primary germ cell tumors are most often the pineal and suprasellar regions. The histological type observed most frequently in these tumors is germinoma. Cases of embryonal carcinoma arising in the basal ganglia are rarely reported. To our knowledge, only 4 such cases have been previously reported in the literature. A case of an embryonal carcinoma arising in the basal ganglia is reported. A 17-year-old boy was admitted to our hospital on July 30, 1988 because of headache and vomiting, and a right hemiparesis. On admission, physical inspection showed no abnormalities and neurological examination revealed obtunded consciousness, a right central facial paresis and a right hemiparesis with Hoffman and Babinski reflexes. Noncontrast CT scan showed a large mass of low-to slightly high-density in the region of the left basal ganglia accompanied with midline shift and ventricular dilatation. Enhancement of the lesion was made by contrast CT scan. It was not homogeneous. Cerebral angiogram displayed a contralateral shift and an unrolling of the anterior cerebral artery, a lateral stretch of middle cerebral artery, a downward stretch of anterior choroidal artery and a tumor stain fed by the Heubner artery. On August 3, left frontotemporal craniotomy was performed. The tumor was totally removed in a piecemeal manner using microsurgical techniques. Histopathological diagnosis was mixed-type of germ cell tumor comprising embryonal carcinoma and teratoma. Postoperative CT scan showed complete disappearance of the tumor. A course of radiation of 4950 rads and two courses of a combination chemotherapy with cis-platinum, vinblastine and bleomycin were given within 3 months after the operation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of embryonal carcinoma arising in the basal ganglia of the cerebrum]. 169 58

An 18-year-old male was admitted with headache, nausea, and vomiting. Computed tomography (CT) revealed an enhanced tumor of the pineal region and hydrocephalus. The tumor was partially resected via a parieto-occipital craniectomy. The histological diagnosis was germinoma. No serum tumor markers such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) were detectable. A ventriculo-peritoneal (V-P) shunt was emplaced and radiation therapy (whole brain 59 Gy) given. The tumor and the hydrocephalus regressed completely and he returned to work. Six years later, he experienced constipation and general fatigue. CT and echotomography of the abdomen showed a large peritoneal tumor and ascites. Laboratory investigation demonstrated serum levels of AFP 7640 ng/ml and HCG 150 IU/l, and high ascitic levels of AFP 12,890 ng/ml and HCG 1030 IU/l. AFP and HCG levels regressed after combined chemotherapy. However, he died due to leukopenia and pneumonia. Autopsy found no metastasis of tumor cells to the central nervous system. The peritoneal cavity contained hemorrhagic fluid and a large tumor 4100 g in weight. The tip of the V-P shunt tube was in front of the tumor. No neoplasm was found in the testis, retroperitoneal cavity, thymus, and other organs. The microscopic appearance of the peritoneal tumor was different to the first pineal tumor. The neoplasm was confirmed as a mixed germ cell tumor with teratoma components and suspected to be a metastasis of the pineal tumor through the V-P shunt system.
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PMID:[Abdominal metastasis of a pineal region tumor through ventriculoperitoneal shunt. Case report]. 172 35

Brainstem tumors arise in portions of the rhombencephalon and mesencephalon. Some authorities include diencephalic tumors in this group. We have reviewed our clinical experience of 69 children (less than 21 years of age) with brainstem tumors evaluated and treated at Duke University Medical Center (DUMC) from 1960 to 1986. There were 19 patients with group 1 tumors (thalamus, third ventricle region, or midbrain) and 50 with group II tumors (pons, medulla oblongata). The common presenting signs and symptoms were ataxia, headache, motor loss, and cranial nerve palsies. The most commonly employed diagnostic imaging studies were air examinations and CT. Preradiotherapy confirmation of malignancy was obtained in five group I patients (astrocytoma, 4; germinoma, 1) and 8 group II patients (astrocytoma, 3; anaplastic astrocytoma, 2; glioblastoma multiforme, 3). All patients received radiotherapy. The 5-year survival rate for the entire population was 40%. The survival rate for group I patients was significantly better than that observed for group II patients. In the 50 group II patients neither patient sex nor age nor presence of cranial nerve palsies nor pretreatment CT scan findings nor field size influenced survival. A long duration of symptoms positively influenced survival. The vast majority of tumor recurrences were within the radiation field. Half of the patients had either stable or improved Karnofsky status 6 months following completion of irradiation. The management strategy for childhood brainstem tumors is discussed.
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PMID:Selection of a management strategy for pediatric brainstem tumors. 270 33

A case of primary intrasellar germinoma in a 24-year-old woman is presented. Her initial symptoms were diabetes insipidus and headaches. The neurological examination found no abnormalities, but the endocrinological examination disclosed a deficiency in growth hormone secretion. Her skull x-ray revealed a normal sella turcica, and a computed tomographic scan revealed no abnormal mass in the pituitary fossa, but a slightly enlarged stalk. Magnetic resonance imaging revealed a small tumor in the posterior lobe. Transsphenoidal exploration revealed a germinoma in the posterior pituitary lobe. Six cases of primary intrasellar germinoma, including our case, were reviewed. Our case is considered to be the smallest intrasellar germinoma yet reported.
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PMID:Primary intrasellar microgerminoma detected by magnetic resonance imaging: case report. 277 Oct 17

Germinomas in childhood may arise in both the suprasellar and pineal region, and outcome has been reported to be worse for suprasellar germinomas with a 5-year survival rate of 20% as compared to 60% for pineal germinoma. To determine the factors impacting on outcome, the results of a uniform treatment approach were evaluated and included primary surgical debulking (PSD) and systemic craniospinal axis radiation (CSRT) for suprasellar germinomas. Between 1976 and 1985 ten consecutive patients (seven females, three males) with the pathologically confirmed diagnosis of suprasellar germinoma were treated. Outcome was compared to four male patients with pineal germinoma treated over the same time period and series of patients reported in the literature. At diagnosis the mean age of patients with suprasellar germinoma was 13.9 years (range, 8.9 to 9.4 years). Symptoms were present for a mean of 18 months (range, 2 to 72 months) prior to diagnosis and included diabetes insipidus, anterior pituitary dysfunction, decreased vision, headache, vomiting, and diplopia. Staging studies, including myelography (n = 4) and cerebrospinal fluid cytology (n = 7), disclosed dissemination in only one child. Surgical treatment included biopsy in three cases, partial resection in five, and total resection in two; no permanent postsurgical complications were noted. The mean radiation therapy dose to the tumor site was 4953 cGy (range, 4400 to 5250 cGy) and to the spine 3354 cGy (range, 3000 to 4000 cGy). Patients were followed for a mean period of 5.1 years (range, 1.9 to 10.5 years). One patient with SG who did not receive treatment initially developed a pineal tumor after diagnosis; she was treated with PSD and CSRT and is asymptomatic 5 years later. All the remaining patients are alive and remain disease-free. Surgical resection and CSRT results in excellent disease control for children with suprasellar germinomas, and outcome is similar to those patients with pineal germinoma.
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PMID:Suprasellar germinomas in childhood. A reappraisal. 291 Apr 39

A 28-year-old woman, 1 month post partum, who presented with headache and gradual onset of total ophthalmoplegia of the left eye, was found at transsphenoidal exploration to have a primary intrasellar germinoma. Craniospinal irradiation resulted in complete resolution of the intracranial tumor. Extensive mediastinal metastasis at 8 months after the operation resulted in a fatal outcome.
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PMID:Primary intrasellar germinoma presenting with cavernous sinus syndrome. 273 94

A 22-year-old woman with a history of headaches and secondary amenorrhea is reported. Her physical examination showed a visual acuity loss. An endocrine evaluation revealed hypopituitarism and an elevated level of serum prolactin. Polytomography demonstrated an enlarged sella with a double floor. A computerized tomography (CT) scan revealed an enhancing lesion within the sella turcica with an extension into the suprasellar cistern. A lumbar puncture was performed and the cerebrospinal fluid was found to contain no tumor cells. The patient subsequently underwent a trassphenoidal exploration of the sella and an intrasellar tumor removal. A histological analysis of the surgical specimen revealed a germinoma. A total dose of 3500 rads with lineac was applied to the whole brain postoperatively. Her vision is now normal. The pathogenesis of an intracranial germinoma is briefly discussed, and a review of the literature discloses 48 previous reports of germinoma.
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PMID:[Primary intrasellar germinoma with amenorrhea--a case report]. 332 Apr 1

A 7-year-old boy was admitted to Hokkaido University Hospital complaining of headache and vomiting. On admission he was slightly confused and presented Parinaud's sign. CT scan revealed abnormal high density mass with contrast enhancement effect at the pineal region and obstructive hydrocephalus. Laboratory studies showed the normal value of human chorionic gonadotropin and no trace of alpha-fetoprotein. Germinoma was most suspected based on the findings of CT scan and laboratory studies. The radiation therapy was carried out for a month and CT scan taken after the radiation therapy revealed marked reduction of the size of the tumor at the pineal region, and he was discharged. But he was re-admitted 3 months after the discharge complaining of headache and vomitting again. CT scan showed the recurrence of the tumor and laboratory studies showed abnormal high value of A.F.P. After the ventriculo-peritoneal shunt, the sub-occipital craniectomy was performed by the Stein's approach, and the tumor was removed. Pathologically the tumor was a typical yolk sac tumor. This case is a very interesting case because it suggests an alternation of the element of the germ cell tumor by the radiation therapy. At first admission, germinoma was the main element of the tumor judging from the effectiveness of the radiation therapy and laboratory studies. But the main element of the tumor seemed to have changed to yolk sac tumor after the radiation therapy. The relation between the tumor markers and the types of the germ cell tumor and histopathological characters of the intracranial germ cell tumor were discussed.
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PMID:[Primary intracranial germ cell tumor with abnormal high value of alpha-fetoprotein after the radiation therapy]. 618 90


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