pineal cell tumor
Introduction
Introduction to pineal cell tumor Pineal cell tumor is a tumor that occurs in the parenchymal cells of pineal gland. It can be seen in any age group, but most of them occur in the age group of 25 to 35 years old. Most of the children are pineal somatic tumors, and the ratio of male to female is basically equal. basic knowledge The proportion of illness: 0.002%-0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: coma, hydrocephalus, disturbance of consciousness, stress ulcer
Cause
Pineal somatic cell disease
(1) Causes of the disease
No relevant information.
(two) pathogenesis
The tumor is mostly gray-red, soft in texture and slightly translucent. The tumor can protrude into the third ventricle and grow in invasive growth at the base. It can also be seen in degenerative changes, such as cystic changes, hemorrhage, and unclear surroundings. Observe the tumor cells or loosely distribute them, or aggregate them into small clusters. The cells are large in diameter and have many cytoplasms. They are well differentiated, densely stained with nuclei, and are mostly irregular. There are a small number of blood vessels distributed between tumor cells, sometimes visible tumor cells. Forming a typical and atypical circular arrangement, occasionally forming a pseudo-purple-like group-like structure. After the tumor is malignant, it is separated by numerous slender and staggered protrusions. The periplasm is rich in periplasm and the periplasm and protuberances are both electron-sparing. There are neurosecretory granules, nuclear round, borderless nucleolar structure, aggregation of hollow vesicles in axonal degeneration of axonal membrane, and ultrastructure of pineal blastoma lacking pineal somatic tumor The cell characteristics, the cell body is more shaped, densely crowded into pieces, and the perinuclear and cell bodies are rare.
Prevention
Pineal cell tumor prevention
No special precautions are taken and regular medical examinations are performed.
Through regular physical examinations, abnormalities in the body and risk factors for cancer are discovered, and the risk of malignant tumors is reduced by timely adjustment and treatment. On the other hand, regular physical examination can achieve early detection, early diagnosis, early treatment, ie secondary prevention.
Complication
Pineal cell tumor complications Complications, coma, hydrocephalus, consciousness disorder, stress ulcer
If surgery is performed, different complications may occur depending on the surgical procedure:
1. After the corpus callosum
(1) Postoperative hemiplegia: mostly due to damage to the central vein, recovery is incomplete.
(2) Coma: caused by damage to the internal veins of the brain and large cerebral veins, and the prognosis is poor.
(3) hydrocephalus: partial resection of the tumor caused by unresolved hydrocephalus before surgery, or due to postoperative brain tissue swelling leading to obstructive hydrocephalus, need to be shunt surgery, critical illness, acute disease, rapid drilling of the lateral cerebral ventricle drainage Surgery.
(4) Difficulties in speech and writing: caused by incision of the carcass, the incision should not be excessive in the operation, 3 ~ 4cm can be used, for patients with cross-brained brain should avoid the use of the carcass approach.
2. Via the lateral ventricle triangle
(1) Same-direction hemianopia: caused by radiation and visual cortex due to injury.
(2) hydrocephalus: postoperative cerebrospinal fluid circulation is not smooth, or caused by absorption disorders, if necessary, ventricle-peritoneal shunt or supratentorial-screen subtotal shunt.
(3) Hypothalamic damage: manifested as abnormal body temperature, disturbance of consciousness and stress ulcer, etc., given antacids and awakening drugs, symptomatic treatment.
(4) intraventricular hemorrhage: surgical wounds are large, intraoperative hemostasis is not complete, intraoperative strict hemostasis, postoperative changes in the condition should be promptly reviewed CT, symptomatic treatment.
Symptom
Pineal Somatic Tumor Symptoms Common Symptoms Two eyes can not be loosened by the pineal calcification. The pineal region occupies the lesion. Drinking drowsiness, sensory disturbance, eyeball convergence, numbness... Ataxia, urinary tinnitus
The duration of tumors in the pineal region varies depending on the histological type of the tumor, the location (pre- or posterior) and the size of the volume. The general course of disease is shorter, mostly within 1 year. The clinical manifestations depend on the nature of the tumor. And the location, mainly symptoms of increased intracranial pressure, neurological symptoms and endocrine system symptoms.
1. Increased intracranial pressure
The tumor protrudes to the upper ventricle of the third ventricle and obstructs the upper end of the aqueduct, or develops forward or downward to narrow or block the aqueduct, resulting in early manifestations of obstructive hydrocephalus and increased intracranial pressure, such as headache, vomiting, and fundus edema. And changes in consciousness and so on.
2. Nervous system symptoms
Tumor compression or infiltration of the pineal region and its adjacent structures can also cause damage to the nervous system:
(1) Eye signs: Quadrilateral superior juvenile syndrome (Parinaud syndrome) and Sylvian aqueduct syndrome, tumor destruction in the upper mound and cap area cause eye movement disorder, both eyes can not be seen, pupillary light reflex disorder, Parinaud Syndrome usually only has two eyes on the upper eye, and the cortical cap beam is caused by tumor compression or destruction. If the posterior part of the mound is damaged, the eyes can not be seen under the eyes. Sylvian aqueduct syndrome can not be seen in addition to the eyeball. There is a change in pupillary light response, eyeball convergence function paralysis or paralysis, nystagmus, suggesting that the circumference of the aqueduct (including the front of the aqueduct and the posterior part of the third ventricle) is damaged.
(2) Hearing impairment: When the tumor volume is large, the quadrilateral inferior colliculus and the medial geniculate body may be oppressed, and bilateral tinnitus and hearing loss may occur.
(3) Cerebellar sign: The tumor develops backwards and can compress the upper and upper cranial parts of the cerebellum, causing poor discrimination, ataxia, decreased muscle tone and intentional tremor.
(4) Subthalamic damage: it may be caused by direct invasion or dissemination of the tumor to the lower part of the thalamus. There are also factors that affect the lower part of the thalamus due to the expansion of the ventral crypt in the anterior third ventricle caused by the obstruction of the aqueduct. Symptoms include polydipsia, drowsiness, and centripetal obesity.
3. Endocrine symptoms
Endocrine symptoms are characterized by stagnant or undeveloped sexual development. Normal pineal gland secretes melatonin, which inhibits the function of the pituitary gland, reduces the content of gonadotropins in the pituitary gland and reduces its secretion, while children and prepuberty The function of the pineal gland is active, thus inhibiting the premature development of sexual characteristics. By the time of puberty, the pineal gland gradually degenerates and the sexual characteristics are mature. Therefore, sexual growth retardation can be seen in pineal cells in pineal tumors. A patient with a tumor.
4. Other symptoms
Due to increased intracranial pressure and direct compression of the midbrain, some patients may have seizures, pathological reflexes or even disturbances of consciousness. Tumors in the malignant pineal region may undergo distant metastasis. Common tumors metastasize to the subarachnoid space of the spinal cord, and even to Structures other than the central nervous system, patients with ventricular diversion, tumor cells transfer to the distant along the shunt, spinal cord dissemination can cause damage to the spinal cord and cauda equina, causing nerve root pain or sensory disturbance.
Examine
Examination of pineal somatic tumors
1. CT examination of CT plain tumor can be low density, contour high density or uniform slightly high density lesions, tumors with clear borders of round lesions, can be scattered in small calcification, bilateral lateral ventricle and third ventricle The enlarged part, the lateral ventricle of both sides of the ependymal or subependymal metastasis and the slightly high-density lesions around the third ventricle can be uniformly contrasted.
2. MRI examination MRI examination of tumors in the T1-weighted image showed an equal signal, but also a low signal, while the T2-weighted image is a high signal, sagittal scanning helps to understand the direction of tumor growth and the degree of midbrain compression, The Gd-DTPA enhancement contrast is also a uniform enhancement performance.
Diagnosis
Diagnosis and identification of pineal cell tumor
Diagnosis can be made based on medical history, clinical manifestations, and imaging studies.
