Tumors of the pineal gland are both benign changes, requiring only periodic observation, and neoplasms with a high degree of malignancy, in which it is necessary to start treatment as soon as possible. A symptom of a pineal tumor can be chronic headaches, nausea, vomiting or visual disturbances. What other problems should arouse concern, because they can be a symptom of a pineal tumor and what is the treatment of these changes?
Pineal gland tumorsgenerally constitute - in the entire population - 1% of all intracranial neoplasms. This percentage is slightly different in the youngest patients - pineal gland tumors in children account for 3 to 10% of all intracranial lesions.
For unknown reasons, changes in the pineal gland are more common among Japanese people than among people from other parts of the world.
The pineal gland is a single endocrine gland located in the diencephalon between the upper mounds of the laminae, adjacent to the posterior wall of the ventricle of the third ventricular system of the brain.
This organ performs many important functions - by secreting melatonin, it affects the course of our sleep. Due to the fact that the pineal gland inhibits the secretion of gonadotropes, it prevents premature puberty in children. In addition to these, it is believed that this organ also affects the functioning of the immune system. The pineal gland - like basically any other organ - can be affected by various disease processes. Although some of them - the pineal gland tumors - are generally quite rare, they can still be present.
Contents:
- Pineal gland tumors: causes
- Pineal gland tumors: types
- Pineal gland tumors: symptoms
- Pineal gland tumors: diagnosis
- Pineal gland tumors: treatment
- Pineal gland tumors: prognosis
Pineal gland tumors: causes
Until now, scientists have not been able to determine the causes of pineal tumors. Genes may potentially affect their development - it has been observed that those people who are burdened with the RB1 gene mutation have an increased risk of pineal tumor. It is also suspected that exposure to radiation and various chemicals are factors that increase the risk of developing one of the pineal tumors.
Tumorspineal glands: types
There are many different pineal tumors - they are distinguished from each other by the nature of the lesions (some of them are benign, others are malignant) and the exact cells they originate from. In general, pineal tumors are classified into three groups: lesions originating in pineal gland cells, neoplasms from reproductive cells, and lesions of various origins. 1. Lesions of the pineal gland cells (pinealocytes). These include:
- pineocytoma: a benign lesion that usually grows slowly in size. Typically found in adults,
- pineal parenchymal tumor of intermediate differentiation: lesion found mainly in young adults, characterized by a more aggressive course than pineal gland,
- papillary tumor of the pineal region: a usually large lesion that is seen in both children and adults,
- pineoblastoma: it is one of the primitive malignant neuroectodermal neoplasms, it is characterized by high malignancy and rapid growth, it has a high tendency to neoplastic spreading. It is usually found in young adults,
- trilateral retinoblastoma: pineal tumor accompanied by retinoblastomas in both eyes of the patient, all lesions highly malignant.
2. Pineal gland tumors from reproductive cells. These formations account for more than 50% of all lesions found within the pineal gland. The reproductive cell carcinomas include:
- reproductive disease (germinoma): the most common lesion in this group, much more often developing within the pineal gland in men than in women, with a high tendency to disseminate. The germ cell may secrete placental alkaline phosphatase (PLAP),
- teratoma: the second most common reproductive pineal tumor, distinguished by mature teratomas, immature teratomas and teratomas with neoplastic transformation. In mature teratomas, the tumor can form various tissues - e.g. fat, skin or respiratory epithelium. Teratoma may produce carcinoembryonic antigen (CEA),
- other, much less frequent changes, such as chorionic carcinoma (chorionepithelioma, can secrete beta chains of the chorionic gonadotropin - beta-HCG), carcinoma embryonale, can release beta-HCG, but also alpha-fetoprotein - AFP ) or yolk sac tumor, capable of producing alpha-fetoprotein.
3. Tumorspineal glands of different origins. The most diverse group of pathological changes within the pineal gland, it includes:
- pineal cysts: changes occurring in humans quite often, because according to some authors, they can be found in even 1 in 5 people. Most often, pineal gland cysts do not cause any symptoms and do not require any treatment, but it is only recommended to regularly monitor the patient and have him undergo check-ups to make sure that the lesion does not increase in size,
- astrocytoma: relatively rare tumor within the pineal gland,
- lipoma,
- arachnoid cysts developing around the pineal gland,
- epidermal cyst (epidermal cyst): a congenital change that is usually detected only in the third decade of life, over time - due to the peeling of the epidermis inside the cyst - the epidermal cyst gradually increases in size,
- dermoid cyst: a congenital lesion that occurs many times less frequently than an epidermal cyst. It is usually diagnosed in younger patients, sweat and sebaceous glands may be present within it, and even hair,
- melanoma (melanoma): in its original form, this tumor is derived from melanin-producing cells in the pineal gland.
Primary pineal tumors are listed above. However, other neoplasms may also have metastasized within this organ. The most common metastases to the pineal gland are caused by malignant tumors, incl. lungs, breasts and kidneys.
Pineal gland tumors: symptoms
A significant number of pineal gland tumors do not cause any symptoms - complaints do not appear especially in patients with small lesions in the pineal gland.
However, there are malignant neoplasms of the pineal gland, which increase their size quite quickly, which causes patients to suffer, inter alia, from to the occurrence of increased intracranial pressure.
In addition, the changes may also constrict adjacent structures (e.g. the ventricular system, resulting in disturbances in the flow of cerebral fluid).
In general, the possible symptoms of a pineal tumor include:
- headaches
- nausea
- vomiting
- visual impairment and eye movement disorders
- optic disc swelling
- gait disturbance
- occurrence of Parinaud's syndrome (in this case, the vertical movement of the eyeballs is disturbed, the pupils do not react to light while maintaining the pupils' ability to converge)
- disturbance of consciousness
- imbalance
Pineal tumors in children can appear in a special way. Well, when a patient in this age group experiences a change in the pineal gland, the inhibitory effect of the pineal gland on sexual maturation may be disturbed, which may result in premature puberty (that is, starting this process in boys before the age of 9 or in girls before they are over). 8 years old).
Pineal gland tumors: diagnosis
Often, pineal tumors - due to the fact that most of these changes do not give any symptoms - are diagnosed accidentally, when the patient is under imaging examinations of the head for some reason.
In a situation where there are symptoms suggesting the presence of an intracranial lesion in the patient, imaging tests, such as computed tomography or magnetic resonance imaging, are usually ordered. The above-mentioned examinations may lead to the visualization of the lesion within the pineal gland. stating its presence does not make it possible to determine its exact nature.
For this reason, patients undergo further tests, such as, for example, a lumbar puncture (to determine whether there are cancerous cells in the cerebrospinal fluid).
If it is suspected that the patient's lesion is a germ cell tumor, blood tests may be valuable - it is possible to determine the presence of tumor markers (such as the aforementioned alpha-fetoprotein or the cancer antigen). However, the definitive answer to the question of what type of pineal tumor is, one gets only after carrying out histopathological examinations. The material for them is obtained by biopsy.
Sometimes it is performed before the start of comprehensive treatment, but more and more often a surgical procedure is planned, during which material is collected, intraoperative histopathological examination is performed and only after the result is obtained, the final decision on the scope of the operation is made.
Pineal gland tumors: treatment
Surgical procedures play a fundamental role in the treatment of pineal tumors. However, they are carried out only when necessary, i.e. when the patient has symptoms related to the presence of a lesion in the pineal gland or when the patient has a malignant tumor.
In the case of small, asymptomatic lesions in the pineal gland, which are most likely to be mild, it is only possible to observe whether the lesion grows in size.
Besides treatmentsurgical, in the case of pineal tumors, radiotherapy and chemotherapy are also used. The exact procedure depends on the exact type of pineal tumor in the patient.
Pineal gland tumors: prognosis
The prognosis of patients with pineal tumors depends on the exact type of cancer they develop. For example, in the case of pineal disease, the prognosis is really good - complete removal of the tumor mass makes the risk of relapse drastically low, and 5-year survival is recorded in more than 85 to even 100% of operated patients.
In the case of reproductive diseases, 5-year survival is reached in 9 out of 10 patients who are treated with radio- and chemotherapy. The prognosis for pineal gland tumors, however, can also be much worse - this is the case, for example, in the course of three-sided retinoblastoma, where it may take only several months from diagnosis to death of the patient. Well, at the beginning of the twentieth century - due to, inter alia, the fact that the operational access to the pineal gland is quite limited - the mortality rate associated with such operations was as high as 90%. Later, however, with the advent of various devices (including surgical devices with microscopes), the effects of surgical treatment of pineal tumors improved significantly and now the prognosis of patients with pineal gland tumors is much better than in the past.
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- Neurology, scientific editor W. Kozubski, Paweł P. Liberski, ed. PZWL, Warsaw 2014
- Baranowska-Bik A., Zgliczyński W., Tumors of the pineal gland, Postępy Nauk Medycznych, vol. XXVIII, No. 12, 2015, ed. Borgis
- Jeffrey N Bruce, Pineal Tumors, October 2022, Medscape; on-line access: https://emedicine.medscape.com/article/249945-overview