Skip to main content

Table 1 Timeline showcasing the relevant events from episode of care

From: Primary neuroendocrine tumor of the pineal gland: a case report

Past medical history: Hypertension
Date Summary Diagnostic Testing Intervention
January 2018 Patient presented with five-day history of vomiting, weakness, balance difficulties, and headaches. CT head: aggressive pineal tumor with hydrocephalus. Started on IV steroids and transported to tertiary care centre.
January 2018 Patient experiencing symptoms of hydrocephalus.   Third ventriculostomy, biopsy of the pineal tumor, and insertion of external ventricular drain and ICP monitor.
February 2018 Patient experienced minimal symptom relief from drain placement.   Surgical subtotal resection of the pineal tumor for symptom relief.
March 2018 Patient continued to experience symptoms from hydrocephalus. CT head: hydrocephalus. Ventriculoperitoneal shunt placed.
March 2018 Patient assessed by Medical Oncology and Radiation Oncology. The patient was ECOG-4 at that time.
Incidental hyperparathyroidism and hypercalcemia discovered after Endocrinology consultation.
PET-CT: no evidence of FDG-avid neoplasia elsewhere in body. Small renal lesion noted. No systemic intervention or radiotherapy at that time due to patient’s performance status.
April 2018 The patient remained in ECOG-4. The patient and family wished to return home.   Discussion held with patient and family. Decision for the patient to return to his community hospital for palliative care.
May 2018 The patient’s condition improved significantly during rehabilitation to ECOG-2.   Patient discharged from community hospital.
June 2018 Patient reassessed by Radiation Oncology. MRI head and spine: enlargement of pineal tumor. No evidence of drop metastases within spinal column.  
July 2018 Radiation regimen of 54 cGy in 30 fractions to primary tumor and resection cavity. 3600 cGy in 20 fractions to craniospinal axis.   
July 2018 Patient reassessed by Medical Oncology. Discussion held with the patient and family members about the role of systemic therapy with palliative intent.   The patient was provided with information about temozolomide and capecitabine. Systemic therapy planned for post-radiation.
September 2018 Radiotherapy completed. The patient started temozolomide alone based on ECOG, but experienced significant toxicity, resulting in hospital admission. MRI head and spine: residual tumor slightly decreased in size post-radiotherapy. Further chemotherapy held.
December 2018 Patient reassessed by Medical Oncology. MRI head: slight decrease in size of residual tumor with stable edema and hydrocephalus. No further systemic therapy at this time. Continued surveillance. Referral to Palliative Care for best supportive care.
March, April 2019 Routine follow-ups with Radiation Oncology. MRI head: stable residual tumor size.  
June 2019 Patient noticed posterior neck swelling. Biopsy: metastatic disease.
MRI cervical spine: at least four enhancing lesions.
Biopsy of neck mass performed.
July 2019 Patient reassessed by Medical Oncology and Radiation Oncology. Planned for radiotherapy to control metastatic disease with possible platinum-based chemotherapy post-radiation.   
August 2019 Patient became unwell before radiotherapy attempted.   No radiation due to decline in performance status. .
September 2019 The patient’s condition deteriorated and was admitted to hospital for palliative care, where he later died.   
  1. Abbreviations: CT Computed tomography, IV Intravenous, ICP Intracranial pressure, ECOG Eastern Cooperative Oncology Group, MRI Magnetic resonance imaging