ABSTRACT
OBJECTIVE: Patients with brain tumors often report having visual complaints. This may be due to increased intracranial pressure, compression/invasion of the optic pathway or diplopia. We assessed the incidence and the etiology of visual symptoms in patients with intracranial germinoma tumors (ICGTs). METHODS AND MATERIALS: We performed a blinded retrospective review of the clinical charts and the initial magnetic resonance imaging (MRI) of 28 patients with ICGT. Thirteen tumors were pineal, five suprasellar, seven bifocal, and further three involved either the optic nerve, the corpus callosum, or the brainstem. RESULTS: Twelve patients reported visual disturbances, seven of whom mainly experienced a decrease in vision. Two of those were initially managed as "retrobulbar neuritis" when endocrinologic symptoms prompted assessment by MRI. Involvement of the optic pathway was underestimated, and both relapsed. Field deficits were definitive sequelae, whereas visual acuity was sometimes regressive in the absence of optic atrophy. CONCLUSIONS: Compression or invasion of the optic pathway by germinomas is not a rare occurrence, and this possibility should not be overlooked when thickening or contrast enhancement is detected. Radiotherapy fields should be extended accordingly.
Subject(s)
Brain Neoplasms , Diplopia , Germinoma , Magnetic Resonance Imaging , Nerve Compression Syndromes , Optic Nerve Diseases , Adolescent , Adult , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/epidemiology , Brain Neoplasms/physiopathology , Child , Diplopia/diagnostic imaging , Diplopia/epidemiology , Diplopia/physiopathology , Female , Germinoma/diagnostic imaging , Germinoma/epidemiology , Germinoma/physiopathology , Humans , Intracranial Pressure , Male , Nerve Compression Syndromes/diagnostic imaging , Nerve Compression Syndromes/epidemiology , Nerve Compression Syndromes/physiopathology , Optic Nerve/diagnostic imaging , Optic Nerve/physiopathology , Optic Nerve Diseases/diagnostic imaging , Optic Nerve Diseases/epidemiology , Optic Nerve Diseases/physiopathology , Retrospective StudiesABSTRACT
BACKGROUND: The hemato-oncology community has been seriously concerned about the H1N1 pandemic of 2009. Here, we report on the evaluation of the immunogenicity and tolerability of H1N1v monovalent vaccines in young patients with cancer during this pandemic. PROCEDURE: Between December 7, 2009 and February 26, 2010, 20 children receiving chemotherapy for solid tumors at the Institute of Hematology and Pediatric Oncology of Lyon, were immunized by 2 doses of either AS03-adjuvanted or nonadjuvanted vaccine. The level of specific antibodies was assessed at D21 and D42. RESULTS: Seroconversion was observed in 13 of the 20 cases (65%), and 18 of 20 cases (90%) had protective titers after the 2 doses. Exploratory univariate analysis failed to show a significant influence of prevaccination lymphocyte counts on seroresponse rates. CONCLUSIONS: These data suggest that H1N1v monovalent vaccines were well tolerated by young cancer patients while on chemotherapy and achieved protective immune response in most cases.