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

TL;DR

A young man's rare and aggressive pineal tumor was misdiagnosed initially, highlighting challenges in diagnosis and the need for multidisciplinary treatment.

Contribution

This case study emphasizes the importance of accurate diagnosis and interdisciplinary care in managing recurrent high-grade pineal tumors.

Findings

Initial MRI identified a solid cystic pineal tumor causing obstructive hydrocephalus.

Histopathology confirmed pineoblastoma after initial misdiagnosis as a low-grade tumor.

Multimodal treatment included surgery, irradiation, and chemotherapy to manage recurrence.

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 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.

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