Kiwanuka Lydia, Weerarathna Induni Nayodhara, Rahul Neha, Jules Manishimwe, Luharia Anurag, Quazi Zahir
Department of Medical Radiology and Imaging technology, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, Maharashtra, 442001, India.
Department of Biomedical Sciences, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, Maharashtra, 442001, India.
Radiol Case Rep. 2025 Mar 27;20(6):2988-2994. doi: 10.1016/j.radcr.2025.03.011. eCollection 2025 Jun.
Pineoblastomas are rare, severe primary brain tumors originating in the pineal gland. They might be challenging to detect and cure. This article recounts the example of a 23-year-old man who suffered from regular headaches and visual issues. During the first MRI, a solid cystic tumor in the pineal area was identified, creating obstructive hydrocephalus by squeezing surrounding brain regions. A low-grade glial tumor was discovered during the operation, which included partial tumor excision and an endoscopic third ventriculostomy. However, follow up imaging revealed a rapid recurrence requiring external ventricular drainage and a second craniotomy. Following the second surgery, histopathology confirmed pineoblastoma, demonstrating the aggressive character of the tumor. Postoperative imaging showed persistent illness despite these measures, requiring the implementation of a comprehensive treatment strategy. The multidisciplinary team suggested craniospinal irradiation (35 Gy in 21 fractions) followed by lesion boost (19.8 Gy in 11 fractions), using VMAT (Volumetric modulated Arc therapy) technique, along with concurrent chemotherapy followed by adjuvant chemotherapy. This case illustrates the difficulties in identifying and managing recurrent pineal tumors, including the need for appropriate adjuvant treatment, surgical constraints, and recurrence concerns. It provides crucial information regarding the challenges of treating aggressive brain tumors and emphasizes the need for interdisciplinary care to achieve the best results. This is a rare case of Central Nervous system recurrent tumor, which was earlier thought to be a low grade pineal tumor but later turns out to be high grade, Pineoblastoma in a young adult male. The case emphasizes the challenges in correct diagnosis of CNS tumors, importance of Immunohistochemistry and prompt management for complete cure of the disease.
松果体母细胞瘤是起源于松果体的罕见且严重的原发性脑肿瘤。它们的检测和治疗可能具有挑战性。本文讲述了一名23岁男性的病例，他经常头痛并伴有视觉问题。在首次磁共振成像（MRI）检查中，发现松果体区域有一个实性囊性肿瘤，该肿瘤挤压周围脑区导致梗阻性脑积水。手术中发现是一个低级别胶质瘤，手术包括部分肿瘤切除和内镜下第三脑室造瘘术。然而，后续成像显示肿瘤迅速复发，需要进行脑室外引流和二次开颅手术。第二次手术后，组织病理学确诊为松果体母细胞瘤，显示出该肿瘤的侵袭性。尽管采取了这些措施，术后成像仍显示病情持续，需要实施综合治疗策略。多学科团队建议采用容积调强弧形放疗（VMAT）技术，进行全脑全脊髓照射（21次分割，共35 Gy），随后对病灶进行加量照射（11次分割，共19.8 Gy），同时进行同步化疗，之后进行辅助化疗。该病例说明了识别和管理复发性松果体肿瘤的困难，包括需要适当的辅助治疗、手术限制以及复发问题。它提供了有关治疗侵袭性脑肿瘤挑战的关键信息，并强调了跨学科护理以取得最佳结果的必要性。这是一例罕见的中枢神经系统复发性肿瘤病例，该肿瘤最初被认为是低级别松果体肿瘤，但后来被证实是高级别松果体母细胞瘤，发生在一名年轻成年男性身上。该病例强调了中枢神经系统肿瘤正确诊断的挑战、免疫组织化学的重要性以及为完全治愈疾病进行及时管理的重要性。
