PINEALOMA (pinealoma; lat. pinea a pinecone + - oma; synonym: pimealoma, epiphyseal struma) — tumor, coming from parenchyma of a pinus. By data A. P. Burlutsky (1962), P. is made by 0,4 — 1,52% of all tumors of a brain. P.'s most is observed at children's age, a thicket at boys.
Having quite continuous topo-grafo-anatomic relationship with the next structures of a brain, P. often puts pressure on chetverokholmy (a roof of a mesencephalon, T.), the brain trunk, a cerebellum, the roller of a corpus collosum, squeezes a water supply system of a mesencephalon (a water supply system of a brain, T.), quite often grows into a cavity of the III ventricle. Ectopic P., i.e. the tumor arising from sites with an atypical arrangement of a pinus, napr in the field of an optic chiasm is rather seldom observed.
It is established that pinus (see) treats neurosecretory formations of a brain and during puberty exerts a certain braking impact on gipotalamo-pituitary system, detaining sexual development. P.'s growth is followed by destruction of fabric of a pinus. It causes loss of its braking influence and leads to premature puberty (see. Hypergenitalism ) and to physical development.
Macroscopically P. has an appearance of a node of gray-pink color of a dense consistence.
On degree of a maturity of this tumor distinguish: the pimealoma which is the most mature tumor and on a structure approaching a normal pinus; the pinealoma of classical «two-cellular type» consisting of less differentiated cells of a pinus and a pinealoma as malignant option P. The last is characterized by expansive and infiltrative growth, sometimes gives metastasises in the intershell space of a head and spinal cord.
The clinical picture
At children, sick P., is noted early change of milk teeth, the strengthened growth of an organism, the accelerated intellectual development, change of a voice and early emergence primary and secondary sexual characteristics. At boys are noted the heavy growth of hair in pubic, axillary areas and on an upper lip, a macrogenitisomia (inappropriate I will increase increase in external genitals). At girls signs of premature puberty are characterized by early emergence of periods, the hypertrophy of mammary glands and small vulvar lips raised by sexual excitability, dysfunctional uterine bleedings. Also symptoms of impact of a tumor on the next formations of a brain are characteristic of P. In the course of P.'s growth forces out cerebrospinal liquid from median departments of the tank of a big brain vein and fills space between a plate a chetverokholmiya and the roller of a corpus collosum, breaking circulation of cerebrospinal liquid at the level of an opening it is mashed a cerebellum. Further the tumor squeezes or sprouts a plate of a roof of a mesencephalon which physiological role generally comes down to transfer of visual and acoustical impulses on oculomotor muscles, pupils, muscles of a neck and a trunk. The Chetverokholmny syndrome is most often shown by paresis of a look up, a partial or full pupillary areflexia on light at safety of convergence, and also change of hearing. Much more rare there is paresis of a look down, disturbance of convergence, spontaneous converging nystagmus (see), ptosis (see).
Striking a plate of a roof of a mesencephalon, P. narrows a gleam of a water supply system of a mesencephalon and breaks circulation of cerebrospinal liquid on cerebral cavities. The block of likvorny ways arising sometimes at the level of a water supply system of a brain and an opening it is mashed a cerebellum promote development giperten-zionno-gidrotsefalnogo the syndrome which is shown pristupoobrazny headaches, nausea, vomiting, dizziness, sometimes forced position of the head, doubling and blackout, noise in the head, a ring in ears, numbness of the person and trunk, development of developments of stagnation on an eyeground, etc. (see. Occlusal syndrome ). Extending forward, the tumor makes immediate effect on upper parts of a brain trunk and visual hillocks of a brain (a back thalamus, T.), what is clinically shown by attacks of sharp tonic tension of extensive muscles of a trunk, neck, top and bottom extremities, and also change of pulse and breath, disturbance of consciousness, a spontaneous nystagmus, most often horizontal which is quite often combined with vertical or diagonal nystagmus (see).
The back departments P. puts pressure upon a cerebellum. The cerebellar frustration noted at the same time are characterized by dominance of disturbances of a statics and gait over coordination frustration. Patients at whom these disturbances are expressed sharply cannot sit, stand, go; in cases of easy statokinetic frustration instability in Romberg's pose is noted (see. Romberg symptom ) and during the walking.
the Diagnosis is based on characteristic a wedge, a picture and data of a special research. Data are of great importance for P.'s diagnosis kraniografiya (see). At the same time secondary (hyper-tenzionno-gidrotsefalnye) symptoms of a disease can be revealed as primary (petrifikata in the field of a pinus), and. Petrifikata can be single and multiple, in the form of small and big conglomerates, to-rye can be displaced in the transverse and front-back direction. Dovolnd considerable all-brain changes on EEG with existence of delta waves and patol, slow waves often come to light. At a research cerebrospinal liquid (see) often reveal the increased protein content, is more rare — a lymphocytic pleocytosis. Importance in P.'s diagnosis, size discrimination and the directions of its preferential growth have data of positive ventrikulografiya (see) and a computer tomography (see. Tomography computer ). Differential diagnosis is carried out with tumors of a brain, to-rye proceed from a tire mesencephalon (see), upper parts cerebellum (see), basal kernels, and also with inflammatory occlusion of a water supply system of a mesencephalon and aneurisms of a big brain vein (see. Aneurism of vessels of a brain ).
Treatment and Forecast
Treatment generally operational. However an operative measure is connected with a number of dangerous complications, to-rye can arise both during operation, and in the postoperative period. Apply the palliative operations directed to elimination of occlusal more often hydrocephaly (see), with the subsequent radiation therapy. Carry out also symptomatic treatment.
Forecast, as a rule, adverse. At timely treatment in some cases it is possible to prolong life of the patient for months and even for years.
Bibliography: Burlutsky A. P. Tumors of strobiloid gland, M., 1962; Tumours of a brain, under the editorship of A. I. Arutyunov, page 64, M., 1970; The Guide to pathoanatomical diagnosis of tumors of the person, under the editorship of N. A. Krayevsky and A. V. Smolyannikov, page 296, M., 1976; Surgery of the central nervous system, under the editorship of V. M. Ugryumo-va, p.1, page 458, JI., 1969; Pecker J. and. lake of Treatment in tumors of the pineal region, value of stereotaxic biopsy, Surg. Neurol., v. 12, p. 341, 1979; Ziilch K. J. Histological typing of tumors of the central nervous system, Geneva, 1979.
K. Ya. Ogleznev.