Recurrent pineal tumor in a young adult male: Challenges in diagnosis and multimodal treatment management
Abstract
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…
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