RESUMEN
OBJECTIVE: Tumors of the hypothalamic-pineal region may present with a wide variety of symptoms, including disturbed eating. We present a case where such a tumor was misdiagnosed as anorexia nervosa. METHOD: We describe a case of pineal germinoma invading the hypothalamus, which was initially diagnosed as anorexia nervosa. RESULTS: Clinical features included weight loss, vomiting, pyrexia, hypernatraemia, and visual disturbance and the typical psychopathology of anorexia nervosa was absent. CONCLUSION: Organic disorder should always be considered before making a diagnosis of anorexia nervosa, particularly if the presentation is atypical.
Asunto(s)
Anorexia Nerviosa/diagnóstico , Neoplasias Encefálicas/patología , Germinoma/patología , Glándula Pineal/patología , Pinealoma/patología , Adulto , Neoplasias Encefálicas/radioterapia , Diagnóstico Diferencial , Errores Diagnósticos , Germinoma/radioterapia , Humanos , Hipotálamo/patología , Hipotálamo/efectos de la radiación , Imagen por Resonancia Magnética , Masculino , Invasividad Neoplásica/patología , Glándula Pineal/efectos de la radiación , Pinealoma/radioterapiaRESUMEN
BACKGROUND: Stereotactic biopsy followed by cytoreductive surgery and/or radiation are the standard treatment for pineoblastoma. We are reporting a patient with a relatively large pineoblastoma, who was treated with a combination of nonresective treatment modalities. METHOD: The patient is a 20-year-old woman who presented with signs and symptoms of raised intracranial pressure. Magnetic resonance imaging (MRI) showed a large tumor in the pineal region and hydrocephalus. She was emergently treated by placement of a ventriculoperitoneal shunt. Three days later she underwent a stereotactic biopsy, which showed the tumor to be pineoblastoma. She was then further treated with the following treatment modalities: permanent implantation of high activity I125 seeds, external radiation, and chemotherapy. RESULTS: At 10 months' follow-up, MRI showed complete disappearance of the tumor. At 18 months' follow-up, the patient is asymptomatic, neurologically intact, and her MRI scans show no evidence of intracranial or intraspinal tumor. CONCLUSIONS: Though the follow-up is relatively short, the results of the nonresective approach in this patient have been excellent.
Asunto(s)
Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/radioterapia , Glándula Pineal , Pinealoma/tratamiento farmacológico , Pinealoma/radioterapia , Adulto , Braquiterapia/métodos , Neoplasias Encefálicas/diagnóstico , Quimioterapia Adyuvante , Femenino , Humanos , Radioisótopos de Yodo/uso terapéutico , Imagen por Resonancia Magnética , Glándula Pineal/patología , Pinealoma/diagnóstico , Radioterapia AdyuvanteRESUMEN
A case of primary multiple germinomas occurring in the corpus callosum and thalamus with excellent outcome following biopsy and irradiation is reported. The pathogenesis of intracranial germinoma is briefly discussed.
Asunto(s)
Neoplasias Encefálicas/patología , Neoplasias Primarias Múltiples/patología , Pinealoma/patología , Adulto , Neoplasias Encefálicas/radioterapia , Cuerpo Calloso , Humanos , Masculino , Pinealoma/radioterapia , TálamoRESUMEN
On the basis of 3 cases of hypothalamic tumours (glioma of the hypothalamus or of the stem of the pituitary, glioma of the hypothalamus or of the optic chiasma, pinealoblastoma), the authors emphasise: (1) the existence of a special endocrine "formula" since it often combines anterior pituitary insufficiency, diabetes insipidus and moderate hyperprolactinaemia; (2) the remarkable efficacy, in all 3 cases, of cobalt therapy, tumour regression becoming complete during the 6 to 10 months following the end of radiotherapy; (3) the post-radiotherapeutic endocrine complications, endocrine deficit becoming greater whilst the tumour disappeared; (4) the diagnostic possibilities and above all regular surveillance now made possible by tomodensitometry.