Pediatric suprasellar germ cell tumor
Introduction
Introduction to children's saddle germ cell tumor The histological features of saddle-top germ cell tumors are basically the same as those of pineal region germ cell tumors, but their clinical features are unique. Germ cell tumors include germinoma, embryonal carcinoma, yolk sac tumor (endodermal sinus tumor), choriocarcinoma, and teratoma. Among them, the incidence of germ cell tumors is the highest, followed by teratoma. The saddle upper germ cell tumor is more common in children. The clinical manifestation depends on the location of the tumor. Common pineal body symptoms, increased intracranial pressure, local symptoms and sexual development abnormalities, such as urine collapse in the saddle area. basic knowledge The proportion of the disease: the disease is rare, about 0.0001% - 0.0002% Susceptible people: children Mode of infection: non-infectious Complications: Diabetes insipidus
Cause
Causes of germ cell tumor in children
(1) Causes of the disease
The saddle upper germ cell tumor originated from the third ventricle and the pituitary stalk germ cells, and the cause was unclear.
(two) pathogenesis
The typical saddle-top germ cell tumor originates from the bottom of the third ventricle and the pituitary stalk. The local growth can oppress the lower part of the hypothalamus, the optic chiasm and adjacent structures. A few originate from the saddle to the saddle, which can invade the optic nerve or optic chiasm to thicken it. Deformation, similar to optic glioma, poor differentiation of saddle upper germ cell tumor, high degree of malignancy, local invasive growth, and the incidence of dissemination or metastasis along the cerebrospinal fluid circulation and blood circulation is also higher than the pineal region High, about 33%, originated from germ cells, invasive growth, mostly gray-red, soft and brittle, visible bleeding, cystic changes and calcification, microscopic tumors from large tumor cells and small lymphoid two The composition of the cells is round or polygonal, the cytoplasm is rich, the nucleus is large, and the chromosome is small; the lymphocytes are present in the interstitial or mixed with the tumor cells, and the malignancy of the tumor is grade II-III.
Prevention
Prevention of germ cell tumor in children
The etiology of saddle-top germ cell tumor is unknown. According to the prevention methods of general tumors, understanding the risk factors of tumors, and formulating corresponding prevention and treatment strategies can reduce the risk of tumors. There are two basic clues to prevent tumors. Even if tumors have begun to form in the body, They can also help the body increase resistance, as described below:
1. Avoid harmful substances (promoting factors): It can help us avoid or minimize exposure to harmful substances.
Some related factors of tumorigenesis are prevented before the onset, and many cancers can be prevented before they are formed. A report in the United States in 1988 compared the international malignant tumors in detail and proposed many external factors of known malignant tumors. In principle, it can be prevented, that is, about 80% of malignant tumors can be prevented by simple lifestyle changes, and traced back. In 1969, Dr. Higginson's research concluded that 90% of malignant tumors are caused by environmental factors," "Environmental factors", "lifestyle" refers to the air we breathe, the water we drink, the food we choose to make, the habits of activities, and social relationships.
2. Improve the body's immunity against tumors: Can help to strengthen and strengthen the body's immune system and cancer.
The focus of our current cancer prevention efforts should first focus on and improve those factors that are closely related to our lives, such as quitting smoking, eating properly, exercising regularly, and losing weight. Anyone who follows these simple and reasonable lifestyles can Reduce the chance of cancer.
The most important thing to improve the function of the immune system is: diet, exercise and control troubles. Healthy lifestyle choices can help us stay away from cancer. Maintaining good emotional state and proper physical exercise can keep the body's immune system at its best. Tumors and prevention of other diseases are equally beneficial. Other studies have shown that appropriate activities not only enhance the body's immune system, but also reduce the incidence of colon cancer by increasing the peristalsis of the human intestinal system. Here we mainly understand the diet in preventing tumorigenesis. Some questions.
Human epidemiology and animal studies have shown that vitamin A plays an important role in reducing the risk of cancer. Vitamin A supports normal mucosa and vision. It directly or indirectly participates in most of the body's tissue functions. Vitamin A is present in animal tissues. In the liver, whole eggs and whole milk, the plant is in the form of -carotene and carotenoids, which can be converted into vitamin A in the human body. Excessive intake of vitamin A can cause adverse reactions in the body and -carrot This is not the case with carotenoids, and the low vitamin A content in the blood increases the risk of malignant tumors. Studies have shown that those with low levels of vitamin A intake in the blood increase the likelihood of lung cancer, while those with low blood levels in smokers Levels of vitamin A ingestors have the potential to double lung cancer. Vitamin A and its mixture can help remove free radicals in the body (free radicals can cause damage to genetic material), and secondly stimulate the immune system and help differentiate cells in the body. Ordered tissue (while the tumor is characterized by disorder), some theories suggest that vitamin A can help early carcinogens Invasion mutated cells become reversed the occurrence of the normal growth of cells.
In addition, some studies suggest that supplementation with -carotene alone does not reduce the risk of cancer, but rather increases the incidence of lung cancer. However, when -carotene binds to vitamin C, E and other antitoxin substances, its protective effect. It is shown, because it can increase free radicals in the body when it is consumed by itself. In addition, there are interactions between different vitamins. Both human and mouse studies have shown that the use of -carotene can reduce 40% of vitamins in the body. At E-level, a safer strategy is to eat different foods to maintain a balanced vitamin to protect against cancer, as some protective factors have not been discovered so far.
Vitamin C, E is another anti-tumor substance that prevents the harm of carcinogens such as nitrosamines in food. Vitamin C protects sperm from genetic damage and reduces the risk of leukemia, kidney cancer and brain tumors in their offspring. Vitamin E can reduce the risk of skin cancer. Vitamin E has the same anti-tumor effect as vitamin C. It is a scavenger that protects against toxins and scavenges free radicals. The combination of vitamins A, C and E protects the body against toxins. Better than applying it alone.
At present, research on phytochemistry has attracted widespread attention. Phytochemistry is a chemical found in plants, including vitamins and other substances found in plants. Thousands of plant chemicals have been found, many of which have anticancer properties. The protective mechanism of these chemicals not only reduces the activity of carcinogens but also enhances the body's immunity against carcinogens. Most plants provide antioxidant activity that exceeds the protective effects of vitamins A, C, and E, such as a cup of cabbage. Contains 50mg of vitamin C and 13U of vitamin E, but its antioxidant activity is equivalent to the antioxidant activity of 800mg of vitamin C and 1100u of vitamin E. It can be inferred that the antioxidant effect in fruits and vegetables is far better than what we know. The effect of vitamins is strong, and no doubt natural plant products will help prevent cancer in the future.
Complication
Pediatric saddle germ cell tumor complications Complications diabetes insipidus
Visual field of vision disorder, diabetes insipidus, growth retardation, etc., prone to dissemination and metastasis.
Symptom
Symptoms of germ cell tumors in children's saddles Common symptoms Urinary collapse pituitary dysfunction Vision defect Isotropic hemianopia Vision centripetal reduction Weight loss ectopic intracranial pressure increased
The course of disease is long, the main clinical manifestations are diabetes insipidus, visual field of vision disorder and hypothalamic-pituitary dysfunction. Some patients may have increased intracranial pressure (11%). Diabetes insipidus occurs in almost all children. For the first symptom, the direct compression of the optic nerve or obstruction of the interventricular space caused by increased intracranial pressure can lead to primary or secondary atrophy of the optic nerve, and visual acuity decline, visual field defects can be manifested as bilateral hemianopia, isotropic hemianopia or visual field Concentricity, hypothalamic-pituitary dysfunction can indicate growth retardation, short stature or weight loss.
Examine
Examination of germ cell tumor in children
1. Cerebrospinal fluid examination: Because such tumors are prone to subarachnoid dissemination and metastasis, cerebrospinal fluid exfoliative cytology has important diagnostic value.
2. Serum examination: due to the original embryonic characteristics of the tumor, the dynamic measurement of alpha fetoprotein (AFP), chorionic gonadotropin (HCG) and tumor antigen (CEA) in serum for the diagnosis, efficacy evaluation and recurrence of the disease The monitoring has a certain significance, CEA can be slightly elevated, AFP increased in order: germ cell tumor, teratoma, endodermal sinus tumor and choriocarcinoma, HCG increased from high to low in order of choriocarcinoma, Germ cell tumor, embryonal carcinoma and endodermal sinus tumor.
3.CT: The tumor is located in the upper saddle pool, showing a slightly high-density mass, the boundary is clear, the texture is uniform, and the enhanced scan shows uniform enhancement. The difference from the pituitary tumor is that the sella has no enlargement; the difference with the craniopharyngioma is that Cystic calcification is rare.
4.MRI: The tumors are characterized by abnormal T1 and T2 signals in the saddle. Some patients may have only the thickening of the pituitary stalk. The enhanced scan shows obvious enhancement. Some tumors are huge and develop to the saddle and saddle. Intensification, as shown in Figure 1, MRI can better display the high signal of the pituitary stalk and normal neurohypophysis, which is helpful for differential diagnosis.
Diagnosis
Diagnosis and identification of germ cell tumor in children
School-age children with a history of long-term diabetes insipidus, especially girls, when combined with visual field damage or growth retardation, increased intracranial pressure, should consider the possibility of this disease, can further neurological examination or cerebrospinal fluid and blood Laboratory inspection.
The disease needs to be differentiated from children with craniopharyngioma, pituitary tumors and optic glioma.
