Your friend is only 20 years old, there are such possibilities: the possibility of malignant tumors in young people (such as gliomyofibroma), and a kind of adenomas (such as pituitary tumors)
Your friend should have done a CT or magnetic **** vibration to qualitatively should be no problem!
A group of researchers at the University Hospital of Grenoble in southeastern France and at the European Synchrotron Radiation Facility (ESRF) (described in a separate article) have discovered a new treatment for improving the survival rate of rats with high-grade gliomas. The experiment was conducted on the ESRF medical beamline, and after a year of treatment, three out of 10 rats were considered cured, while all of the untreated ones died. In the near future, this technology will be clinically tested on humans.
Neurogliomas are a common brain tumor in adults and are not curable. 5-10 out of 100,000 adults have intracranial neurogliomas, and the average survival rate for patients is less than a year. Traditional radiation therapy using hospital x-rays is only curative, as gliomas are among the most radiation-resistant human tumors and chemotherapy is ineffective most of the time. Several therapeutic techniques have been developed for use in animal experiments over the past several years, but none have been as successful as the efficacy of treatment using Cis-platinum, one of the most commonly used anti-cancer therapeutic chemotherapeutic agents, coupled with monochromatic synchronized X-ray therapy. This new technology combines both chemotherapy and radiation therapy to produce good results. (The ESRF device is shown at left.)
In this study, the drug Cis-platinum was injected into the brains of rats with F98 gliomas. The drug entered the DNA of the tumor and inhibited its spread. The following day, the tumors were photographed with very precise-energy (monochromatic) X-rays on ESRF's medical beamline. The difference between these X-rays and the usual X-ray sources used in hospitals is the brightness: the beam stream produced by ESRF's synchrotron is 100,000 times brighter than that produced by the hospital's X-ray machine and can be easily adjusted to the desired wavelength. (Members of the research team are pictured at right.)
The in vivo experiment was performed before it was carried out using the same tumor sample (F98) on cells. The tumor was extremely resistant to radiation therapy and spread very rapidly. The average survival rate for untreated rats was 28 days. If injected with the drug cis-platinum, they had a survival rate of 39 days. If the rats were irradiated with a certain wavelength of X-rays, they survived for up to 48 days. Combining the two treatments with a specific dose of radiation and a specific wavelength of X-rays appeared to be the most effective treatment, giving an average survival time of about 200 days. This means that rats treated in this way survived six times as long compared to rats that did not receive the treatment.
Gliomas, or gliomas for short, are tumors that occur in the neural ectoderm. There are two types of tumors occurring in the neural ectoderm, one formed by mesenchymal cells, called gliomas, and the other formed by parenchymal cells, called neuronal tumors. Because these two types of tumors cannot be completely distinguished from each other pathologically and morphologically, and gliomas originating from mesenchymal cells are much more common than neuronal tumors originating from parenchymal cells, neuronal tumors are included in gliomas and collectively referred to as gliomas.
There are many ways to categorize gliomas, and clinicians tend to use the simpler Kernohan classification. Among the various types of gliomas, astrocytomas are the most prevalent, followed by glioblastomas, and then medulloblastomas, ventricular meningiomas, oligodendrogliomas, pineal tumors, mixed gliomas, choroid plexus papillomas, unclassified gliomas, and neuronal tumors in descending order. Each type of glioma has a different site of occurrence, such as astrocytomas in adults are mostly found in the cerebral hemispheres, while children are more likely to be found in the cerebellum; glioblastomas are almost always found in the cerebral hemispheres; medulloblastomas are found in the earthy part of the cerebellum; ventricular meningiomas are most often found in the fourth ventricle; and oligodendroglial tumors are found in most of the cerebral hemispheres.
Gliomas are more common in men, especially in glioblastoma multiforme and medulloblastoma, which are significantly more common in men than in women. Glioblastomas of all types are most common in middle age, ventricular meningiomas in children and young adults, and medulloblastomas almost always occur in children. There is also a relationship between the location of gliomas and age, e.g., astrocytomas and glioblastomas of the brain are most often seen in adults, and gliomas of the cerebellum (astrocytomas, medulloblastomas, and ventricular meningiomas) are most often seen in children.
Most gliomas are slow-onset, with the time between the onset of symptoms and presentation at the clinic typically ranging from weeks to months, and in a few cases, years. There is a shorter history of highly malignant and posterior cranial fossa tumors and a longer history of more benign or sedentary tumors. Symptoms can worsen suddenly if the tumor has hemorrhage or cystic lesions, or even have an onset similar to cerebrovascular disease. The clinical symptoms of glioma can be divided into two aspects, one is the symptoms of increased intracranial pressure, such as headache, vomiting, vision loss, diplopia, psychiatric symptoms, etc.; the other is the focal symptoms produced by the tumor compression, infiltration, and destruction of brain tissues, which can be manifested as irritation symptoms such as limited epilepsy in early stage, and neurological deficit symptoms such as paralysis in later stage.
The diagnosis of glioma is based on the analysis of its biological characteristics, age, gender, prevalent sites and clinical course. Based on the history and physical signs, using electrophysiology, ultrasound, radionuclide, radiology and nuclear magnetic **** vibration and other auxiliary examinations, the localization correctness rate is almost 100%, and the correctness rate of the qualitative diagnosis can be more than 90%. The treatment of glioma is mainly based on surgical treatment. Since the tumor has infiltrative growth and has no clear demarcation from the brain tissue, it is difficult to be completely resected, and postoperative radiotherapy, chemotherapy and immunotherapy are extremely necessary. The principle of surgical treatment is to remove the tumor as much as possible under the premise of preserving nerve function. Early stage tumors that are small and located in appropriate areas can be completely resected. Tumors located in the frontal or temporal lobes can be lobotomized. When the tumor in the frontal or temporal lobe has a wide range and cannot be completely resected, the frontal pole or temporal pole can be resected at the same time for internal decompression surgery. If the tumor is located in the motor or speech area without obvious hemiparesis or aphasia, attention should be paid to the preservation of neurological function, and the tumor should be appropriately resected to avoid serious sequelae. For ventricular tumors, it is advisable to cut the brain tissue from non-functional area to enter the ventricle, resect the tumor as much as possible, and release the cerebral obstruction. For gliomas located in the thalamus and brainstem, except for small nodular or cystic tumors that can be resected, shunt surgery is usually performed to relieve the increased intracranial pressure, and then radiation therapy and other comprehensive treatments are carried out. Radiation therapy should be carried out as soon as possible after the recovery of the general condition after surgery.
Chemotherapy for gliomas tends to be a combination of drugs, according to the cell kinetics and the specificity of the drug to the cell cycle, with several drugs to improve the efficacy. For example, nitrosoureas are used in combination with VCR and PCB, or with VM26, ADM, methotrexate (MTX) and bleomycin (BLM). In order to increase the local drug concentration and reduce systemic toxicity, special routes of drug delivery can also be used, such as through the Ommaya reservoir, local injection of ADM, MTX, through selective catheters from the artery supplying blood to the tumor injected cancer drugs.
Immunotherapy for glioma, including active immunization with tumor vaccine, injection of immune ribonucleic acid into lymph nodes, and application of immunomodulators such as levamisole, PSK, PSP, etc., are also in clinical use, which can alleviate the reaction to radiotherapy and chemotherapy, and enhance the effect of immunity.
Inhibition of tumor angiogenesis therapy for glioma, at present, bufotanine is the most ideal gene-expression drug for inhibition of tumor angiogenesis therapy for glioma.
Diagnosis of gliomas
Diagnosis is made on the basis of age, sex, site of occurrence, and clinical course, and the type of pathology is estimated. In addition to the history and neurological examination, some auxiliary tests are needed to help diagnosis localization and characterization.
(1) Cerebrospinal fluid (CSF) examination: the pressure of lumbar puncture is mostly increased, and some tumors located on the surface of the brain or in the ventricles of the brain may increase the amount of protein in the CSF, and the number of leukocytes may also be increased, and in some cases, tumor cells may be detected. However, if the intracranial pressure is significantly increased, lumbar puncture may promote the risk of cerebral herniation. Therefore, it is usually done only when necessary, such as the need to identify with inflammation or hemorrhage. For those with significant pressure increase, the operation should be performed with caution and not more cerebrospinal fluid should be released. Postoperative mannitol drip is given, and attention is paid to observation.
(2) ultrasonography: it can help to determine the side and observe the presence or absence of hydrocephalus. For infants, B-mode ultrasound scanning can be performed through the fontanel, which can show tumor images and other pathological changes.
(3)Electroencephalogram examination: the electroencephalogram changes of glioma are on the one hand the changes of brain waves confined to the tumor site. On the other hand, there are general widely distributed changes in frequency and wave amplitude. These are influenced by tumor size, infiltrative nature, degree of cerebral edema, and increased intracranial pressure, etc. Superficial tumors are prone to confined abnormalities, while deeper tumors are less likely to have confined changes. In the more benign astrocytomas, oligodendrogliomas, etc., the main manifestation is confined δ waves, and in some cases epileptic waveforms such as spikes or sharp waves are seen. Large pleomorphic glioblastomas may show extensive δ waves, sometimes only fixed lateral.
(4) Radioisotope scanning (Y-ray encephalography): fast-growing blood-rich tumors have high permeability of blood-brain barrier and high isotope uptake. For example, glioblastoma multiforme shows isotope-concentrated image, and in the middle, there may be low-density area formed by necrosis and cysts, which should be distinguished from metastatic tumor according to its shape and multiplicity. Astrocytomas and other benign gliomas have a lower concentration, often slightly higher than the surrounding brain tissue, and the image is not clear, and some of them can be negative.
(5) Radiologic examination: including cranial plain film, ventriculography, electronic computed tomography scan. Cranial plain film can show signs of increased intracranial pressure, tumor calcification and pineal calcification displacement. Ventriculography can show cerebrovascular displacement and tumor vascularization. These abnormal changes, which are different in different parts and types of tumors, can help locate and sometimes even characterize the tumor. Especially, CT scan has the greatest diagnostic value. Intravenous contrast enhancement scanning has almost 100% localization accuracy, and the correct rate of qualitative diagnosis can be more than 90%. It can show the location, scope, shape, brain tissue reaction and ventricular compression and displacement of the tumor. However, it still needs to be considered together with the clinic in order to make a clear diagnosis.
(6)Nuclear magnetic **** vibration: the diagnosis of brain tumor is more accurate than CT, the image is more clear, and it can find the tiny tumor which can not be shown by CT.
Positron emission tomography can get images similar to CT, and can observe the growth and metabolism of tumors and identify benign and malignant tumors.
Clinical manifestations of gliomas
The course of gliomas varies according to the type of pathology and location, and the time from the onset of symptoms to diagnosis is usually a few weeks to a few months, with a few cases lasting several years. The history of highly malignant and posterior cranial fossa tumors tends to be shorter, and the history of more benign tumors or tumors located in the so-called quiet zone tends to be longer. In tumors with hemorrhage or cyst formation, the progression of symptoms may be accelerated, and in some cases may even resemble the progression of cerebrovascular disease.
There are two main manifestations of symptoms. One is increased intracranial pressure and other general symptoms, such as headache, vomiting, vision loss, diplopia, seizures and mental symptoms. The other is local symptoms resulting from compression, infiltration, and destruction of brain tissue by the tumor, resulting in neurological deficits.
Headache is mostly due to increased intracranial pressure. Tumor growth gradually increases intracranial pressure, which compresses and involves intracranial pain-sensitive structures, such as blood vessels, dura mater and certain cranial nerves, and produces headache. Most of the headaches are throbbing and swelling pains, which are mostly in the frontotemporal or occipital area. For tumors that are superficial to one cerebral hemisphere, the headache may be mainly on the affected side, and the headache may be intermittent, mostly occurring early in the morning, and then worsening and prolonging with the development of the tumor.
Vomiting is due to the stimulation of the medullary vomiting center or vagus nerve, which may be without nausea first, and is projectile. In children the vomiting may be more prominent due to the separation of the cranial sutures from the headache and because tumors of the posterior cranial fossa are common.
Increased intracranial pressure can produce optic papillary edema, and for a long time lead to secondary atrophy of the optic nerve, vision loss. Tumor compression of the optic nerve produces primary atrophy of the optic nerve, also resulting in vision loss. The adductor nerve is easily compressed and pulled, often leading to paralysis and diplopia.
Some patients with tumors have epilepsy, which can be an early symptom. Epilepsy begins in adulthood the latter is usually symptomatic and mostly due to brain tumors. Drugs are not easy to control or the nature of the seizures have changed, should be considered the presence of brain tumors. Epilepsy is common in tumors adjacent to the cortex and rare in those deep within. Limited epilepsy is of localizing significance.
Some tumors, especially those located in the frontal lobe, may gradually develop psychiatric symptoms, such as personality changes, apathy, decreased speech and activity, lack of concentration, memory loss, lack of concern for things, and lack of knowledge of neatness.
The local symptoms are according to the location of the tumor, and the symptoms are aggravated progressively. In particular, malignant glioma grows faster, infiltrates and destroys brain tissues, and the surrounding cerebral edema is significant, so the local symptoms are more obvious and develop faster. In the early stage of intracerebroventricular tumors or tumors located in the quiet zone, there may be no local symptoms. Tumors in the brainstem and other important functional parts of the brain appear local symptoms in the early stage, and symptoms of increased intracranial pressure appear only after a long time. In some tumors with slow development, the symptoms of increased intracranial pressure often appear only in the late stage due to the compensatory effect.
Pathogenesis of glioma
With gradual enlargement of the tumor and formation of intracranial space-occupying lesions, often accompanied by peripheral cerebral edema, increased intracranial pressure occurs when the compensatory limit is exceeded. When the tumor blocks the cerebrospinal fluid circulation or compresses the veins, resulting in impaired venous return, the intracranial pressure increases even more. The process can be accelerated by hemorrhage, necrosis and cyst formation within the tumor. When the increase in intracranial pressure reaches a critical point, there continues to be a small increase in intracranial volume, and the intracranial pressure will increase rapidly. If intracranial pressure monitoring is performed, when the pressure reaches 6.67-13.3kPa Hg, plateau waves appear, and the repeated appearance of plateau waves with a long duration is a clinical sign. When the intracranial pressure is equal to the arterial pressure, the cerebral blood vessels are paralyzed, the cerebral blood flow stops, the blood pressure drops, and the patient will die soon.
The tumor increases in size, the local intracranial pressure is the highest, and the pressure gradient between the intracranial cavities is generated, resulting in cerebral displacement, and cerebral hernia is formed when it is gradually aggravated. Tumors of the supratentorial cerebral hemisphere can produce subcerebral herniation, and the cingulate gyrus is moved over the midline, which can cause wedge-shaped necrosis. The pericallosal artery can also be displaced by pressure, and in severe cases, cerebral infarction can occur in the supply area. More importantly, the cerebellar vermis herniation occurs when the medial sulcus of the temporal lobe is displaced to the posterior cranial fossa through the cerebellar vermis. The ipsilateral motor nerve is paralyzed by compression, the pupil is dilated, and the light response is absent. Compression of the cerebral peduncle in the midbrain produces contralateral hemiparesis. Sometimes the contralateral cerebral peduncle presses against the edge of the cerebellar vermis or the apophysis, producing ipsilateral hemiparesis. Compression of the posterior choroidal artery and posterior cerebral artery may also cause ischemic necrosis. Finally, compression of the brainstem may produce downward axial displacement, leading to infarction and hemorrhage in the midbrain and upper pontine. The patient is comatose, blood pressure rises, pulse is slow, respiration is deep and irregular, and de-cerebralization may occur. Eventually, respiration stops, blood pressure drops, and death occurs due to cardiac arrest. Tumor of posterior cranial fossa under the curtain may produce hernia of the foramen magnum occipitalis, and the cerebellar tonsils are displaced downward to herniate out of the foramen magnum occipitalis. In severe cases, the medulla oblongata ventrally presses on the anterior border of the foramen magnum. Supratentorial tumors can also be associated with occipital foramen magnum hernia. As a result of medullary ischemia, the patient becomes comatose, blood pressure rises, pulse is slow and strong, and respiration is deep and unplanned. Subsequently, respiration stops, blood pressure decreases, pulse is rapid and weak, and death occurs.
Epidemiology of gliomas
Gliomas are the most common among various intracranial tumors. Among gliomas, astrocytoma is the most common, followed by glioblastoma multiforme, and ventricular meningioma occupies the third place. According to the statistics of Xuanwu Hospital in Beijing and the Affiliated Hospital of Tianjin Medical College, among 2573 cases of gliomas, they accounted for 39.1%, 25.8% and 18.2% respectively.
Gender is more common in males, especially in glioblastoma multiforme and medulloblastoma, which are significantly more common in males than females. Most of the cases were found in the age group of 20 to 50 years, with the highest peak in the age group of 30 to 40 years, and another small peak in the age group of 10 years, which was more common in children.
Each type of glioma has its own age of prevalence, such as astrocytomas, glioblastoma multiforme, ventricular meningiomas, medulloblastomas, and medulloblastomas, most of which occur in children. The sites of occurrence of various types of gliomas are also different, such as astrocytomas occurring in the cerebral hemispheres of adults and in the cerebellum of children; glioblastomas with polymorphic features occurring almost exclusively in the cerebral hemispheres; ventricular meningiomas occurring in the fourth ventricle; oligodendroglial neoplasms occurring in the cerebral hemispheres in the majority of cases, and medulloblastomas occurring in the cerebellum in the cerebellar earth part in almost all cases.
Pituitary tumors
Pituitary tumors|Pituitary tumors are common benign tumors with an incidence of 1/100,000, accounting for 10% of intracranial tumors. Pituitary tumor is a common benign tumor with an incidence rate of 1 in 100,000, accounting for 10% of intracranial tumors and the third most common tumor in the brain. It is prevalent in young adults and its hazards are mainly manifested in the following aspects: 1) excessive secretion of pituitary hormones causing metabolic disorders and damage to organs, 2) compression by the tumor, causing low pituitary hormones and hypoplasia in the target glands, and 3) compression of pteronasal structures such as optic intersection, cavernous sinus of the optic nerve, basilar artery, hypothalamus, ventricles of the brain, even the involvement of the frontal lobe, temporal lobe, and the brainstem, resulting in serious dysfunction. Pituitary Tumor|Pituitary Tumor Classification of pituitary tumor|pituitary tumor:1 prolactin cell adenoma 2 growth hormone cell adenoma 3 adrenocorticotropic hormone cell adenoma 4 thyrotropin cell adenoma 5 gonadotropin adenoma 6 polysecretory function cell adenoma 7 anaplastic endocrine function cell adenoma 8 malignant pituitary adenoma
Clinical manifestations of pituitary tumor|pituitary tumor:
***Same features:
1, headache, early 2/3 patients have headache, mild, intermittent attacks.
2. Visual field impairment.
3, the tumor backward compression of the pituitary stalk and hypothalamus, manifested as urolithiasis, hypothalamic dysfunction; the involvement of the third ventricle, interventricular foramen, the conduit can cause symptoms of intracranial pressure, to the frontal lobe can cause psychiatric symptoms, epilepsy, olfactory dysfunction and so on.
Prolactin adenoma: prolactin increase, estrogen decrease can cause amenorrhea, must breast, infertility; pituitary hypoplasia can manifest fatigue, lethargy, hypogonadism, mental abnormality, hair loss, obesity and so on.
PRL>100ug/IL (normal, male<20ug/L, female<30ug/L)
Growth hormone adenoma: growth hormone increase, can cause acromegaly, gigantism; sexual function hypogonadism, amenorrhea, infertility; due to the sleep on the hypertrophy of the tongue and the pharynx and so on the collapse caused by sleep apnea syndrome, GH5- 10ug/L, 90% of the hypopituitary function can be manifested by weakness, sleepiness, mental abnormalities, hair loss, obesity. 10ug/L, 90% higher than 10ug/L (normal 2-4ug/L)
Adrenocorticotropic hormone adenoma: manifested as Cushing's syndrome, centripetal obesity, full-moon face buffalo back, hypogonadism or infertility, etc. Urinary Free Cortisol (UFC) >100ug that is, diagnostic significance (normal 20-80ug/24).
Thyroid stimulating hormone cell adenoma: due to increased TSH secretion T3, T4 increase, manifested as hyperthyroidism symptoms.
Gonadotropin-stimulating cell adenoma: hypogonadism, amenorrhea, infertility.
Non-secretory cell adenoma: also known as smoky cell tumor, early asymptomatic, when the tumor grows large compression of the visual cross and pituitary tissue manifested as headache, visual dysfunction and hypopituitarism (in the order of gonadal, thyroid, adrenal hypopituitarism or a mixture of symptoms of the body characteristics.)
Pituitary adenocarcinoma: infiltrative growth with surrounding adjacent tissues, with distant metastases, which manifests as a functional pituitary adenoma.
Current treatments for pituitary tumors|pituitary tumors include surgery, drugs and radiation therapy.
1. Surgery: the rate of good results of pituitary adenoma surgery is 60-90%, but the recurrence rate is higher, the foreign data is 7-35%, and the recurrence rate of those who resected purely can reach 50%. Its recurrence is related to the following factors: ① incomplete surgical resection, tumor tissue residual tumor ② tumor erosive growth, involving dura mater, cavernous sinus or bone tissue ③ multiple pituitary microadenomas, ④ pituitary cell hyperplasia.
2, drug therapy only for a part of the cases have certain efficacy. For example, bromocriptine can be used to treat PRL adenoma, GH adenoma, ACTH adenoma, growth inhibitory hormone or estrogen can be used to treat GH adenoma, cyproheptadine can be used, methylphenidate can be used to treat ACTH adenoma, and various hormone replacement therapies can be used for palliative treatments to alleviate the symptoms to varying degrees, but they can not be cured fundamentally, and the symptoms recur after the discontinuation of the drugs, and the tumor continues to increase in size.
3. Radiation therapy: It is applied to pituitary adenomas and pituitary carcinomas that are not completely operated or may recur, and X-knife and R-knife are applied to tumors less than 3 centimeters. Although radiation therapy for pituitary adenomas has a certain therapeutic efficacy, the dose and efficacy of radiation therapy as well as the damages to the pituitary hypoplasia, optic nerve and peripheral vascular and neurological structures have yet to be further researched.
Traditional Chinese medicine treatment: The expert group of our hospital adopts anti-tumor series of formulas and Chinese medicine capsule with the application of rare animals and precious Chinese herbs selected and developed, and the expert group according to the physiological characteristics of brain tumors and the development of the law of heterogeneity, heterogeneity, metastasis. Using the method of combining modern medicine and traditional Chinese medicine, the expert group prompts the traditional Chinese medicine to enter the brain through the blood-brain barrier, penetrate the tumor tissues, close the blood circulation of the tumor tissues, make the normal brain cells divided in an orderly manner, enter the tumor directly to play the role of phagocytosis and elimination, improve the microcirculation of the brain, so as to make the blood-oxygen metabolism enhance, the foci of the lesions soften and shrink. It adopts different treatment methods according to different conditions, and the staged treatment is suitable for patients who have not been operated or partially resected after operation, recurrence after operation, X-knife, γ-knife, and after radiochemotherapy, and it is especially effective in the treatment of headache, nausea and vomiting, tinnitus, numbness of limbs, convulsions, mental disorders, and unclear and double vision caused by brain tumor, and it is generally effective to relieve or eliminate the symptoms within 10-20 days with the medication. Or eliminate symptoms, most patients 3-6 months to make the tumor calcification, shrink or disappear, can prevent recurrence, clinical application for many years the efficacy of the exact.