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IPSILATERAL CEREBRAL ATROPHY CAUSED BY ECTOPIC PINEALOMA: REPORT OF A CASE Yoku Nakagawa 1 , Izumi Hamazima 1,3 , Yuhzoh Iwasaki 1 , Kenzoh Yada 1 , Haruhiko Kunita 2 1Dept. of Neurosurgery, Hokkaido Univ. School of Med. 2Dept. of II Int. Med., Hokkaido Univ. School of Med. pp.69-75
Published Date 1973/1/1
DOI https://doi.org/10.11477/mf.1406203260
  • Abstract
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Although dilatation of the ventricular system is commonly ohserved in case with brain tumors, especially in those which is related to cerebrospinal fluid passway, it is rare to observe secondary atrophy of the ipsilateral cerebral hemisphere before removal of the neoplasm, and also without increased intra-cranial pressure. The authors found only five such cases in the literature, all of which were the cases with ectopic pinealoma.

The patient reported here is a 15-year old Japanese female who was admitted to Hokkaido University Hospital on Oct. 16, 1968 with chief complaints of difficulty in walking, impaired visual fields, poly-dipsia and polyuria. These symptoms have been first noticed approximately two years prior to admis-sion and did not change much till the time of the admission. Examination on admission revealed left homonymous hemianopia without macular spairing, spastic hemiparesis on the left side and diabetes incipidus. There were no signs or symptoms to indicate increased intracranial pressure. Cerebro-spinal fluid pressure measured by lumbar puncture was 70 mm H2O, and it contained 22 mg/dl of total protein. Plain skull X-ray revealed no abnormalities, and no calcification was seen in the region of the pineal body. Carotid angiogram showed displace-ment of the anterior cerebral artery toward right side (fig. 1). Pneumoencephalogram with lamino-graphic studies showed dilatation of the anterior part of the right lateral ventricle and enlargement of the cerebral sulci on the same side (fig. 2-3). Because of these findings, without establishing de-finitive diagnosis, the patient was discharged on Feb. 5, 1969, to be followed by out-patient department.

The patient was readmitted on June 9, 1969, be-cause of progression of the left hemiparesis and of disturbance of consciousness. Lumbar puncture on this admission showed initial pressure of 170 mm H2O with total protein of 147 mg/dl. Pneumoence-phalogram was also repeated and it showed further advancement of the dilatation of the right lateral ventricle and widening of the cerebral sulci on the same side (fig. 4).

Exploratory craniotomy was performed on Aug. 27,1969. The entire surface of the right lateral ventricle was covered with grayish-white material of which histological examination turned out to be a typical two-cell pattern pinealoma (fig. 5). Radiation therapy using CO60 was started following to the surgery, but the patient took downhill course and expired on Sept. 16, 1969. On postmortem ex-amination, despite the fact that the neoplastic tissue was diffusely invading widely including the basal ganglia, the internal capsule, the thalamus and the hypothalamus on the right side, the right optic tract, and entire surface of the ventricularsystem, the right cerebral hemisphere showed dif-fuse atrophy which was most marked in the frontal lobe. It was failed to find any neoplastic cells in the pineal body itself.

It is quite interesting that this type of infiltrat-ing neoplasm could cause diffuse atrophy of the cerebral hemisphere before it produces cerebralswelling or blockage of the cerebrospinal fluid pass-way. It is also interesting that despite the fact this type of neoplasm tends to spread along the ventricular wall, the protein content in the cerebro-spinal fluid does not elevate in the early stage.


Copyright © 1973, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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