Pineal Gland Tumour Management In A Tertiary Hospital In Kenya

A Case Report

Abstract

Pineal gland tumours are rare and predominantly childhood malignancies that originate from pineocytes or their precursor cells. The primary neuroendocrine tumour accounts for less than 1% of all primary intracranial tumours. In children, pineal gland tumours account for about 3–11% of all paediatric brain malignancies. Available evidence suggests that these tumours are almost always found in male patients. These tumours are classified based on their origin into germ cell, parenchyma, and metastatic tumours. Also, the tumours in this region can originate from adjacent structures such as astrocytoma, meningioma, and choroid plexus.

This case report aimed at demonstrating diagnostic and management experience and challenges in pineal gland tumours in Kenya. The case reports involve a two and a half-year-old male patient with uneventful birth history and normal developmental milestones who presented in the paediatric emergency unit with a 1-month history of lethargy, anisorcoria, ataxia, visual hallucinations, vomiting, and increasing head circumference. An initial head CT scan showed dilated ventricles and raised intracranial pressure. Immediate neurosurgical intervention involved the insertion of a ventriculoperitoneal shunt.

The diagnosis of pineal gland tumour was made using a 1.5T brain MRI, which was delayed due to financial constraints and limited access to the imaging modality. Definitive management was done through craniotomy and excision of the pineal gland tumor. Intra-operative findings showed a bloody, whitish, suckable tumour that extended into the midbrain, where 80% of the tumour was resected and the biopsy was taken for histology. A repeat non-contrast enhanced brain CT scan post craniotomy and tumour excision showed no new lesions of concern. Post-surgery persistence of right-sided body weakness noted. Histopathology findings showed features of pilocytic astrocytoma.

This case report demonstrates the importance of careful evaluation of suspected cases, especially children, and the clinical importance of pineal gland tumours in paediatric neurosurgery, especially in resource-limited settings, as we gear towards achieving universal health care coverage.