pineal tumor
Introduction
Introduction to pineal tumor The pineal gland is located above the top of the diencephalon and secretes melatonin, which acts in contrast to the melanocyte stimulating hormone (MSH) of the pituitary gland, making the amphibious skin pigments lighter. The pineal gland is a neuroendocrine transducer that acts as a "biological clock" and may inhibit gonad activity. Pineal tumor was proposed by Pellizzi in 1972, also known as precocious puberty syndrome, early maternal giant genital giant syndrome. It refers to the increase of gonadotropin and sex hormone secretion caused by pineal tumor (the secretion function of pineal gland has antagonistic effect on pituitary gland). Common tumors include adult pineal cell tumor, pineal somatic cell tumor, glioblastoma, teratoma, germ cell tumor, seminoma, astrocytoma, ectopic pineal tumor, etc. Less than 1% of intracranial tumors are more common in boys. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: gastrointestinal bleeding, hyponatremia, diabetes insipidus
Cause
Cause of pineal tumor
Taking too much male and female hormones (35%):
Boy: iatrogenic or over-accepted androgen; feminine adrenal cortical tumor, ingestion of exogenous estrogen. Girl: Ingestion of estrogen contraceptives, or use of estrogen-containing external medicine; intake of exogenous androgens.
The impact of disease factors (20%):
Boy: familial hypertestosteroneemia, adrenal hyperplasia or tumor, testicular stromal tumor, ectopic secretion of chorionic gonadotropin, such as central nervous system tumor, malignant embryonal tumor, liver cancer, hepatoblastoma, abnormal Fetal tumors, chorionic epithelial tumors, etc., cause the testes to develop in advance by stimulation of non-pituitary-derived gonadotropins. Girls: feminine adrenal cortical tumors; autonomic ovarian cysts, ovarian tumors, etc., multiple bone dysplasia.
Other (18%):
Excessive use of tonics, etc.
Prevention
Pineal tumor prevention
1. Develop good habits, stop smoking and limit alcohol. Smoking, the World Health Organization predicts that if people no longer smoke, after five years, the world's cancer will be reduced by 1/3; secondly, no alcohol. Smoke and alcohol are extremely acidic and acidic substances. People who smoke and drink for a long time can easily lead to acidic body.
2. Don't eat too much salty and spicy food, don't eat food that is overheated, too cold, expired and deteriorated; those who are frail or have certain genetic diseases should eat some anti-cancer foods and high alkali content as appropriate. Alkaline foods maintain a good mental state.
3. Have a good attitude to deal with stress, work and rest, do not fatigue. Visible pressure is an important cause of cancer. Chinese medicine believes that stress leads to excessive physical weakness, which leads to decreased immune function, endocrine disorders, metabolic disorders in the body, leading to the deposition of acidic substances in the body. Stress can also lead to mental stress causing qi stagnation and blood stasis. Invagination and so on.
4 Strengthen physical exercise, enhance physical fitness, and exercise more in the sun. Excessive sweating can excrete acidic substances in the body with sweat, avoiding the formation of acidic constitution.
5. People who have regular life and irregular living habits, such as singing karaoke, playing mahjong, and not returning to the night, will have aggravated physical acidification and are prone to cancer. Good habits should be developed to maintain a weak alkaline constitution and keep various cancer diseases away from you.
Complication
Pineal tumor complications Complications, gastrointestinal bleeding, hyponatremia, diabetes insipidus
Complications after surgery: intracranial hemorrhage, gastrointestinal bleeding, electrolyte imbalance, hyponatremia, hypernatremia, hypopituitarism, central hyperthermia, diabetes insipidus, cerebrospinal fluid rhinorrhea.
1. If the tumor oppresses the cerebral aqueduct, it can cause intracranial hypertension, and the quadrant of the tumor can cause Parinaud syndrome (can not be seen, the pupils disappear from light reflection, the eyes can not aggregate and the large stride gait).
2. Tumors in the pineal region can cause hypothalamic injury and develop diabetes insipidus.
Symptom
Pineal tumor symptoms common symptoms oculomotor nerve palsy pineal region occupying lesions on light reflexes ataxia ataxia pineal calcification shift gait abnormal calcification dementia drowsiness sleepiness
Symptoms:
Occasionally occurs in 1/3 of children with precocious puberty; tumor compression symptoms may have headache and vomiting; invasion of hypothalamic diabetes insipidus or other hypothalamic neuropsychiatric nervous system, the symptoms are mainly in the two eyes can not see, oculomotor nerve Paralysis, eye movement disorders, ataxia, pupillary reflex changes, including A-Robo pupils sleepiness.
Tumor compression quadruple appears pupil dilated, and the two eyeballs are the same as the up-and-down dyskinesia called quadrilateral syndrome. Can also cause cerebellar ataxia, endocrine symptoms have the characteristics of sexual precocity, and sometimes due to tumor involvement in the third ventricle caused by autonomic disorders such as cyanosis.
Performance of pineal tumors in different locations:
The clinical manifestations of tumors in the pineal region vary with the location of the lesion, and the clinical manifestations depend to a large extent on the size of the tumor and the degree of invasion of peripheral nerve structures.
Brain edema
Tumors in the pineal region invade the third ventricle, causing obstruction to cause an increase in intracranial pressure. Common symptoms are lethargy, headache, vomiting, and mental disorders. In general, the more severe the blockage, the more sudden and obvious the symptoms occur.
2. Nervous system symptoms
The neurological symptoms of pineal tumors are related to the infiltrating nerves and conduction pathways. Thalamic infiltration can cause intermittent pain and paresthesia in unilateral paraplegia, erosive internal capsules cause hemiplegic palsy; involvement of basal ganglia causes extrapyramidal syndrome Or dyskinesia, lack of visual field, and damage to the tetraploid pineal region of the tumor can cause Parinud syndrome, which includes upward gaze, pupillary light reflex, and convergent paralysis wide gait .
3. Hypothalamic pituitary hypofunction
Tumors in the pineal region cause hypothalamic injury and diabetes insipidus, eating more sleepiness, obesity, and abnormal behavior, but also accompanied by visual field damage, water regulation and imbalance of body temperature regulation, and pituitary hypofunction.
4. Precocious puberty
Pineal tumors can often cause precocious puberty, most of which occur in calcification of male pineal tumors. Calcification is seen in the skull. The possible cause of precocious puberty is due to tumor destruction and release of pineal gland. The substance inhibition of pituitary secretion of gonadotropin disappears into precocious puberty, and the tumor may cause damage to the hypothalamus and cause precocious puberty in the pineal region. The pineal tumor causes less delayed puberty, and there are individual cases of gonad hypofunction and pine. It is related to the tumor.
5. Melatonin secretion and regulation abnormalities
It can lead to the circadian rhythm of melatonin secretion in many normal clinical diseases. The serum melatonin level is highest after 10 pm to early morning, while the melatonin rhythm secretion of senile dementia patients disappears.
The anti-oxidation, anti-glutamate excitotoxicity of melatonin and the direct regulation of the expression of apoptotic genes can prevent apoptosis in nerve tissue and contribute to the treatment of senile dementia and Parkinson's disease brain damage epilepsy.
The diagnosis of pineal region tumors must be based on histopathological classification, because the treatment options and prognosis of each type of tumor are very different, and the biggest difficulty is still difficult to obtain histological specimens, thus emphasizing stereotactic pineal region The importance of biopsy of lesions.
Examine
Examination of pineal tumor
Head CT scan MRI can detect tumors and make a localization diagnosis.
Determination of pituitary hormones and its dynamic function tests can help identify pituitary adenomas, especially hormone-secreting pituitary adenomas. HCG determination is helpful in the diagnosis of germ cell tumors. AFP and -assay are determined by sensitive radioimmunoassay. HCG is used as a routine method for diagnosing pineal tumors.
1.HCG-AFP
In patients with hormone-secreting germ cell tumors in the pineal region, the level of HCG-AFP in the cerebrospinal fluid is increased.
2. Cerebrospinal fluid exfoliation cytology
It is most valuable for the diagnosis of germ cell tumors of pineal gland tumors. Because these two tumor cells are easy to fall off, cerebrospinal fluid is implanted, such as cerebrospinal fluid exfoliative cytology, and pathological cells can be clearly diagnosed. Cerebrospinal fluid can stimulate the ventricles. The choroid plexus secretes too much cerebrospinal fluid, resulting in traffic hydrocephalus, so the tumor is small and can be combined with significant hydrocephalus.
3. Hydroxy hydrazine-oxygen-methyltransferase (HIOMT)
Hydroxy hydrazine-oxygen-methyltransferase (HIOMT) is a key enzyme in the final step of melatonin biosynthesis. After in situ hybridization analysis of 3 cases of pineal mesoblastoma and 5 cases of pineal somatic cell tumor by Tsumanuma et al. It was found that these two types of tumor cells preserved the function of expressing HIOMT mR-NA, and elevated MIOMT levels are helpful in the diagnosis of pineal parenchymal tumors.
(1) Previously used gas angiography has been eliminated due to low susceptibility and low sensitivity. Now CT or MRI is selected according to clinical manifestations. CT is the first choice for pineal tumors. It can be used for enhancement and coronal scanning CT. Guided biopsy can obtain a clear pathological diagnosis of the tissue locally in the lesion. Fedorcsak et al. performed 523 CT-guided biopsy tests between 1989 and 1996. It is considered that this method is completely effective in the histological diagnosis of intracranial tumors, and it is necessary to develop a suitable treatment plan.
(2) MRI has unique advantages in the diagnosis of pineal blastoma. The pineal blastoma originates from the malignant degree of the pineal gland, which is invasive, fast-growing, easy to metastasize, and short in patient survival. Therefore, early diagnosis Treatment is very important. MRI showed a high signal in the region of the pineal tumor and a clear indication of the extent to which the tumor invaded the third ventricle.
(3) The radiograph of the head shows a large (>15 mm) flocculated pineal calcification or signs of cerebral edema.
Diagnosis
Diagnosis and diagnosis of pineal tumor
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Differential diagnosis should pay attention to distinguish tumors located outside the pineal region, such as meningioma, hemangioma; adjacent sites, such as brain stem, cerebellar vermis and other tumors; pineal cysts, etc., these diseases and pineal tumors The difference is mainly based on imaging examination. If there is sexual precocity, germ cell tumors are likely to be diagnosed. The final diagnosis depends on pathological examination.
First, hypothalamic syndrome
Clinical manifestations:
Although the hypothalamic volume is small, its function is very complicated. Due to the different lesions, it can be a complex clinical syndrome.
1. Endocrine dysfunction is cold, less sweating, hair loss, polydipsia, polyuria, diabetes insipidus, obesity, loss of libido, impotence, precocious puberty or sexual dysplasia.
2. Occupational lesions cause high intracranial pressure, headache, vomiting, vision loss, and reduced visual field.
3. Eating disorders, bulimia, excessive gluttony with extreme obesity; anorexia, excessive anorexia with extreme weight loss.
4. Sleep and disturbance of consciousness can manifest as drowsiness or insomnia.
5. Body temperature regulation disorder fever can be low heat 37.5 ° C or less, high heat is relaxation type or irregular type; can also be expressed as hypothermia.
6. Mental disorders manifest as excessive excitement, crying and laughing, hallucinations and irritation.
7. Hereditary hypothalamic diseases such as Kallmann's syndrome.
Diagnosis of hypothalamic syndrome:
There are many causes of hypothalamic syndrome. Sometimes it is difficult to diagnose. It is necessary to ask the medical history in detail, and comprehensively analyze the results of the examination. In addition to the diagnosis of the disease, the cause should be further investigated. Commonly used tests: 1 measure the release of hormones in the hypothalamus; Pituitary and target gland endocrine hormones under water and TRH, LRH stimulation test and insulin tolerance test; 3 cerebrospinal fluid examination; 4 EEG; 5X line head flat film, cerebral angiography, skull CT and MRI.
Second, Nothnagel's syndrome
Also known as ophthalmoplegia - cerebellar ataxia syndrome, unilateral eye lesions, impaired ipsilateral eye movement paralysis, often with gaze, especially upward gaze, ataxia gait, uncoordinated upper limb movement, also There is contralateral cerebellar ataxia, which can be combined with lethargy.
