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

A case of pineocytoma associated with intraventricular and meningeal metastasis is reported. The patient, a 25-year-old female, was admitted complaining of headache. Computed tomography revealed an irregular-shaped pineal lesion enhanced by contrast medium and accompanied by a cyst. An intraventricular cystic metastatic lesion and meningeal metastasis were also suggested. Biopsy of the pineal region proved the lesion to be a pineocytoma without neuronal or glial differentiation. Ventriculoperitoneal shunting was performed, and radiation therapy combined with chemotherapy (ACNU and vincristine) was administered. This treatment apparently destroyed both the primary and metastatic lesions, and the patient returned to her normal life. In 4 years of follow-up there has been no recurrence of the tumor. Pineocytoma with meningeal metastasis usually has a poor prognosis, but in this case combined radiation therapy and chemotherapy was curative. Although pineocytoma is rarely accompanied by a cyst, in cases of a pineal lesion coexistent with a cyst, a diagnosis of pineocytoma should be considered.
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PMID:[Cystic pineocytoma successfully treated with synchronized chemoradiotherapy. Case report]. 247 17

A report on a rare case of pineocytoma is presented. A 27-year-old woman visited our clinic because of a 3-month history of intermittent headaches and nausea. A CT scan revealed the presence of a marked obstructive hydrocephalus and mass without any contrast enhancement in the pineal region. Immediately, V-P shunting was performed and resulted in relief of all symptoms. Ventriculography showed a complete occlusion at the aqueductus Sylvii and filling defect at the posterior part of the 3rd ventricle. The patient was operated on in the prone position via infratentorial supracerebellar approach by suboccipital craniectomy on November 9, 1982. A grayish red-colored, well-defined solid tumor located at the pineal region was removed partially. The histopathological appearance of this tumor resembled the pattern of the normal pineal gland. Many cells exhibited a polar form, eosinophilic cytoplasm with the process often being directed toward a blood vessel. The cells around the central areas occupied by pale eosinophilic material were arranged like a "rosette". Combined chemo-radiotherapy was carried out after surgery. That is, a total dose of 4,825 rads to the whole brain was irradiated, and ACNU 140 mg and VCR 6 mg in total were administered intravenously and intermittently. After irradiation therapy, the tumor increased in size producing a ring-like enhancement effect as shown on repeated CT scans. During this time, she started to complain of blurred vision with Parinaud's sign. A second operation via interhemispheric approach by right parietal craniotomy was undergone, and the tumor was partially resected again on March 29, 1983.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Pineocytoma--a case report]. 370 49

We report a case of pineocytoma associated with an unusually large cyst. A 15-year-old boy was admitted with a complaint of intermittent headache. Neurological examination was normal except for bilateral papilledema. CT scan showed triventricular hydrocephalus and a large mass. A solid portion of the tumor in the pineal and retrothalamic areas was isodense, and contained massive calcification on CT. A huge cystic portion extended far into the infratentorial, supracellebellar area. On MR, the solid tumor showed isointensity on T1-WI and iso- to high intensity on T2-WI, and was enhanced by Gd-DTPA. After a ventriculo-peritoneal shunt, the tumor was partially removed through an occipital supratentorial approach. Histological examination revealed a pineocytoma with neuronal and astrocytic differentiations. Reviewing the literature, it is most unusual to find a pineocytoma associated with a huge cyst as was seen in this case.
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PMID:[Pineocytoma associated with a cyst: report of a case]. 747 1

Small asymptomatic cysts of the pineal gland represent a common incidental finding in adults undergoing computerized tomography or magnetic resonance (MR) imaging or at postmortem examination. In contrast, large symptomatic pineal cysts are rare, being limited to individual case reports or small series. The authors have reviewed 24 cases of large pineal cysts. The mean patient age at presentation was 28.7 years (range 15 to 46 years); 18 were female and six male. Presenting features in 20 symptomatic cases included: headache in 19; nausea and/or vomiting in seven; papilledema in five; visual disturbances in five (diplopia in three, "blurred vision" in two, and unilateral partial oculomotor nerve palsy in one); Parinaud's syndrome in two; hemiparesis in one; hemisensory aberration in one; and seizures in one. Four lesions were discovered incidentally. Magnetic resonance imaging typically demonstrated a 0.8- to 3.0-cm diameter mass (mean 1.7 cm) with homogeneous decreased signal intensity on T1-weighted images, increased signal intensity on T2-weighted images, and a distinct margin. Hydrocephalus was present in eight cases. The cysts were surgically excised via an infratentorial/supracerebellar approach (23 cases) or stereotactically biopsied (one case). Histological examination revealed a cyst wall 0.5 to 2.0 mm thick comprised of three layers: an outer fibrous layer, a middle layer of pineal parenchymal cells with variable calcification, and an inner layer of hypocellular glial tissue often exhibiting Rosenthal fibers and/or granular bodies. Evidence of prior hemorrhage, mild astrocytic degenerative atypia, and disorganization of pineal parenchyma were often present. Postoperative follow-up review in all 24 cases (range 3 months to 10 years) revealed no complications in 21, mild ocular movement deficit in one, gradually resolving Parinaud's syndrome in one, and radiographic evidence of a postoperative venous infarct of the superior cerebellum with ataxia of 1 week's duration in one. Of the patients referred for study, the cysts were most often initially misdiagnosed as a pineocytoma in eight and a pilocytic astrocytoma in three. Only two patients were correctly diagnosed as having pineal cysts. This stresses the importance of recognizing the histopathological spectrum of pineal cysts, as well as correlation with radiographic findings, if a correct diagnosis is to be attained.
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PMID:Symptomatic glial cysts of the pineal gland. 811 58

The treatment strategy and prognosis of pineal cell tumors are still subjects of debate because of their rarity and the mixture of pineoblastoma and pineocytoma as components. Pineoblastoma is believed to be the more malignant tumor and total gross resection of this tumor is very difficult because of its invasive tendency and location. Although the effectiveness of external irradiation and chemotherapy has been reported, the outlook for patients with this tumor is extremely poor. We treated a case of pineoblastoma with a single total resection nine months after interstitial irradiation and chemotherapy. In this case, brachytherapy was successful as neoadjuvant therapy for decreasing the tumor's volume and clarifying its boundary. The patient was a 36-year-old woman who had complained of occipital headache for about a month. On admission, neurological examination revealed bilateral papilloedema but, otherwise, there were no deficits. A magnetic resonance image (MRI) showed a homogeneously enhanced tumor in the pineal region and obstructive hydrocephalus. Two weeks after ventriculo-peritoneal shunting, a stereotactic needle biopsy was performed using a BRW MRI-guided stereotactic apparatus, and three catheters for interstitial brachytherapy were implanted into the tumor through the biopsy tract. Iridium-192 seeds were inserted through the catheters and kept there for 8 days to irradiate 40 Gy at the tumor periphery. Four courses of chemotherapy with carboplatin (400 mg/m2) and VP-16 (400 mg/m2) were administered after brachytherapy. Repeat MRI scans every month showed a gradual regression of tumor volume. However, the tumor did not disappear and no further decrease in tumor volume was observed 8 months after brachytherapy. A suboccipital craniotomy was performed 9 months after brachytherapy and en bloc tumor resection was achieved readily via an infratentorial supracerebellar approach. After receiving another course of chemotherapy and external irradiation at 40 Gy, the patient was discharged without any symptoms and no residual tumor or recurrence was observed for 24 months after brachytherapy and 15 months after surgery. The clinical course of this case suggests that a combination of stereotactic biopsy and brachytherapy with chemotherapy followed by surgery may be a good strategy for the treatment of pineal cell tumors regardless of their histopathological features.
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PMID:[Usefulness of neoadjuvant brachytherapy in the treatment of pineoblastoma: a case report]. 869 77

A 58-year-old male suffered a massive intratumoral hemorrhage after placement of a ventriculoperitoneal shunt before treatment for pineocytoma. At admission, he complained of headache, urinary incontinence, gait disturbance, and recent memory disturbance. His neurological examination revealed impaired memory and papilledema from hydrocephalus. Two days after the placement of the ventriculoperitoneal shunt, he suddenly became stuporous and Parinaud's sign appeared. Computed tomography showed a massive intratumoral hemorrhage occupying the third ventricle which had extended into the lateral ventricle. The infratentorial supracerebellar approach was used to remove the hematoma and the tumor. The histological diagnosis was pineocytoma. Intratumoral hemorrhage in pineocytoma after the placement of a ventriculoperitoneal shunt is rare, but should be kept in mind when a ventriculoperitoneal shunt is placed before a craniotomy.
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PMID:Pineocytoma with massive intratumoral hemorrhage after ventriculoperitoneal shunt--case report. 946 90

The authors report a case of pineocytoma in a 44-year-old woman suffering from headache, vomiting and Parinaud syndrome. At histopathological examination the neoplasm showed a ill-defined lobulate pattern with some small pineocytomatous rosettes. The electron-microscopy revealed cells of moderate size and oval nuclei with smooth nuclear envelopes; well-developed organelles were found in the, abundant cytoplasm. The chromosome analysis revealed this kariotype: 58-59, XXX, -4, -5, -13, - 14, -15, + 19. This is the first report of a pineocytoma with ultrastructural and cytogenetic study; it confirms the literature findings of the electron-microscopy, whereas there is partial accordance with the previous cytogenetic studies.
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PMID:Cytogenetic and ultrastructural study of a pineocytoma case report. 1108 76

In the last 11 years we operated on 20 patients (1.03% of all operated brain tumors) with lateral ventricular masses. Anamnesis lasted from 6 months in the case of epileptic seizures to 6 years when headache was the main symptom of disease only. Tumor was located in the anterior cornu and pars centralis in 15, in the trigonum of lateral ventricle in 2, and in the posterior cornu of the lateral ventricle in 3 cases. 13 tumors were large and in MRI the largest diameter was above 5 cm. Tumors located in the anterior cornu and pars centralis were removed using transcortical (10 cases) or transcallosal approaches (5 times). The tumor of the trigonum of ventricle was removed twice through superior parietal lobulus. Tumors of the posterior cornu were operated on via precuneus in order to save visual fields or through the occipital cortex. In 4 cases after removal of tumor the orifice in the frontal lobe was closed with fibrine glue. We totally removed tumors from lateral ventricles in 85% and subtotally in 15% of all cases. Histopathological examination revealed: astrocytoma anaplasticum in 5 cases, astrocytoma pilocyticum 4, oligodendroglioma 2, oligodendroglioma mixtum 1, papilloma plexus chorioidei 2, cystis epidermalis 2, subependymoma 1, ependymoma 1, pineocytoma 1 and haemangiona arterio-venosum 1. Two patients (10%) with diagnosis of anaplastic astrocytoma died after the operation as a result of ischemia and edema cerebri. During the follow-up examination, where the average time of observation was 3.7 years, 15 patients were found to be in a good condition (GR+MD), 1 patient was severely disabled (SD), 2 patients with anaplastic astrocytoma and pineocytoma died because of enlargement of the remnants of tumors left at first operation in spite of reoperation. Tumors of the lateral ventricle grow slowly and often achieve a large size before their clinical appearance. Most of tumors are accessible for a total or subtotal removal with acceptable morbidity and mortality rate after the operation. Long-term results depend on the size of resection and histopathological investigation.
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PMID:[Surgical treatment of intraventricular tumors]. 1535 29

A 61-year-old woman had suffered from severe headache and nausea over 20 times during the last 43 years. An subarachnoid hemorrhage (SAH) was detected by spinal puncture in some other hospitals, but the source of hemorrhage remained unknown in spite of repeated angiography. At the age of 61, she was diagnosed as having normal pressure hydrocephalus, and received a ventriculo-peritoneal shunt. She suffered from sudden headache 12 days after surgery. A CT scan showed a SAH and enlargement of the pineal mass. The tumor was totally removed via the occipital interhemispheric transtentorial approach and was diagnosed histologically as a pineocytoma. She has been free from SAH for three years since removal of the tumor. Pineal apoplexy should be considered as a cause of SAH.
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PMID:[Case of pineocytoma causing repetitive subarachnoid hemorrhage for 43 years]. 1834 Oct 15

We report a boy who in 1994, at the age of 11, presented with headache and vomiting. The fi nal diagnosis was papillary tumor of the pineal region (PTPR). Magnetic resonance imaging (MRI) revealed a heterogeneous mass. Hydrocephalus was addressed by immediate ventricle drainage; subsequently, we attempted tumor removal. As the intraoperative diagnosis of the hemorrhagic tumor was primitive neuroectodermal tumor (PNET), we did not proceed to total removal. After the delivery of radiotherapy (50.4 Gy) and one course of Nimustine hydrochloride (ACNU) chemotherapy, the residual tumor was completely resected. The diagnosis at that time (1994) was papillary pineocytoma. He was followed on an outpatient basis for 15 years and remained free of recurrence. This type of tumor was later proposed to represent a new distinct tumor subtype, papillary tumor of the pineal region (PTPR). Our data indicate that our patient's tumor should be included in this category.
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PMID:Successful treatment of neoadjuvant therapy for papillary tumor of the pineal region. 1985 18


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