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Management and outcome of pineal region tumors
Abstract:
The management and outcome of 45 patients with tumors in the pineal region are reviewed. The overall male to female ratio was 2:1, and over one-half of the patients presented during the 2nd decade of life. Sixteen of the 21 survivors are presently gainfully employed and suffer only minor deficits. Two of 3 survivors in whom the lesion was biopsied harbored germinomas, while the third had an epidermoid. Among the 18 nonsurvivors, all of whom died of their tumors, 15 succumbed within 2 1/2 years of hospital admission. Twelve of the 13 nonsurvivors in whom histological confirmation was obtained by operation or autopsy had malignant tumors. Computed axial tomography was helpful in making the diagnosis of tumor type in 7 of the 11 cases with confirmed pathology. Cerebrospinal fluid cytology disclosed malignant cells in 4 of 11 patients with proven pineal malignancy. Irradiation and shunting were performed in nearly all survivors and in a little over one-half of the nonsurvivors. Where noninvasive studies are equivocal for malignancy, biopsy may be indicated.
Insights
This study reviews 45 pineal region tumors, finding many present in young males. Early diagnosis and treatment, potentially including biopsy, are crucial for improving outcomes in these rare tumors.
Area of Science:
- Neuro-oncology
- Neurosurgery
- Pediatric Oncology
Background:
- Pineal region tumors are rare and challenging to manage.
- Understanding patient demographics and tumor characteristics is vital for effective treatment strategies.
Purpose of the Study:
- To review the management and outcomes of patients with pineal region tumors.
- To identify factors influencing survival and functional status.
- To evaluate the utility of diagnostic modalities.
Main Methods:
- Retrospective review of 45 patients with pineal region tumors.
- Analysis of patient demographics, tumor types, treatment modalities, and outcomes.
- Evaluation of diagnostic accuracy of Computed Axial Tomography (CAT) and Cerebrospinal Fluid (CSF) cytology.
Main Results:
- Over half of patients presented in their second decade of life, with a 2:1 male to female ratio.
- Of 21 survivors, most had minor deficits and were gainfully employed.
- Malignant tumors were prevalent among non-survivors, with rapid progression noted in many cases.
- Computed axial tomography aided in tumor type diagnosis in 7 of 11 confirmed cases.
- Cerebrospinal fluid cytology detected malignant cells in 4 of 11 patients with pineal malignancy.
Conclusions:
- Pineal region tumors often affect young males and require prompt management.
- While many survivors experience good functional outcomes, malignant tumors pose a significant mortality risk.
- Diagnostic tools like CAT scans and CSF cytology can assist in identifying tumor type, but biopsy may be necessary when noninvasive studies are inconclusive.