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Primary medulla oblongata germinomas: two case reports and review of the literature
1Department Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO,6 Tiantan Xili Dongcheng district, Beijing 100050, P R China. zhangliweittyy@aliyun.com.
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.
Insights
Medulla oblongata germinomas are rare and difficult to diagnose preoperatively. Early diagnosis and treatment, including radiotherapy, are crucial for favorable outcomes in these challenging brain tumors.
Area of Science:
- Neuro-oncology
- Neurosurgery
- Radiation Oncology
Background:
- Intracranial germinomas are radiosensitive tumors.
- Germinomas located in the medulla oblongata are exceptionally rare, complicating preoperative diagnosis.
- Accurate diagnosis is essential for effective treatment planning.
Observation:
- Two cases of medulla oblongata lesions underwent surgical treatment.
- Postoperative pathological examination confirmed germinoma in both patients.
- Clinical presentation lacked specific signs, hindering preoperative diagnosis.
Findings:
- One patient achieved complete tumor resolution with surgery, radiotherapy, and chemotherapy.
- The second patient, without adjuvant therapy post-surgery, experienced tumor relapse and succumbed to pneumonia.
- Surgical intervention in the medulla oblongata carries significant risks of functional impairment.
Implications:
- Despite diagnostic challenges, prompt and appropriate treatment, including adjuvant therapies, can lead to favorable prognoses for medulla oblongata germinomas.
- Minimally invasive diagnostic approaches may be warranted to avoid neurological deficits.
- Further research into early diagnostic markers for rare brainstem tumors is needed.
