Abstract
An intracranial germinoma is a tumor that is sensitive to radiotherapy. As medulla oblongata germinomas are extremely rare, determining an accurate preoperative diagnosis is challenging. Two cases of medulla oblongata lesions were surgically treated, and a postoperative diagnosis of germinoma was determined in both of the cases. The tumor in one patient completely resolved after a treatment course consisting of surgical intervention, radiotherapy and chemotherapy; the other patient, who did not receive any type of adjuvant treatment after surgery, suffered from tumor relapse and died from pneumonia 8 months following surgery. A preoperative diagnosis of medulla oblongata germinoma is difficult because of the lack of specific clinical signs and symptoms. If the correct diagnosis is reached, patients can have a favorable prognosis with proper evaluation and treatment. An invasive operation can potentially lesion and impair the function of the medulla oblongata, which is fatal to the patient.
Highlights
Intracranial germinomas constitute 50 to 60% of central nervous system germ cell tumors and are commonly found in the suprasellar, basal ganglia, and pineal midline structures of the brain [1]
An accurate preoperative diagnosis is crucial for prognosticating outcomes for patients because this tumor is sensitive to radiotherapy and chemotherapy [6,7]
We report two rare cases of primary medulla oblongata germinoma
Summary
Intracranial germinomas constitute 50 to 60% of central nervous system germ cell tumors and are commonly found in the suprasellar, basal ganglia, and pineal midline structures of the brain [1]. We report two rare cases of primary medulla oblongata germinoma. The patient returned to school 3 months after surgery (Figure 3). He was followed up for 4 years and has not experienced any tumor recurrence. The patient was diagnosed as having a brain stem tumor 5 years prior and was treated by gamma knife (Figure 4A-B) at another hospital. The T1 and T2 MRI revealed a cystic lesion in the dorsal region of the medulla oblongata with areas of mixed signal intensities (Figure 4C-D). Given the patient’s history of prior radiotherapy, we abstained from treating this patient with another course of radiotherapy for fear of provoking brain stem edema. The tumor relapsed 7 months following surgery and was confirmed by MRI (Figure 4F). The patient died from pneumonia in the eighth month following surgery
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