Mixed germ cell tumor of the midbrain

Abstract

<jats:p>This 14-year-old boy presented with left hemiparesis, gait disturbance, and multiple cranial nerve palsies. Magnetic resonance imaging revealed a multicystic mass with hemorrhagic fluid–fluid levels in the right midbrain, suggesting the presence of a cavernous malformation. Diffusion tensor imaging showed the mass to be close to the right corticospinal tract and ipsilateral medial lemniscus. Subtotal removal of the mass was performed via a right subtemporal approach. The histopathological diagnosis was of a mixed germ cell tumor (GCT) comprising mature teratoma and germinoma cells with syncytiotrophoblastic giant cells. The patient underwent postoperative chemotherapy and radiotherapy, and no tumor progression was found during 1 year of follow-up.</jats:p> <jats:p>Intracranial GCTs arise mainly in the pineal and the suprasellar area. Germ cell tumors in the brainstem are rare, with only 12 reported cases. Among these, 4 were in the midbrain and histologically were pure germinomas. To the authors' knowledge, this is the first reported case of a mixed GCT in the midbrain combining mature teratoma and germinoma cells.</jats:p>

Primary medulla oblongata teratomas

“…However, the residual tumor regrew, and he died 3 months after surgery. The other case, presented by Koh et al, 7 was a 14-year-old boy who harbored a midbrain mixed GCT composed of mature teratoma (95%) and germinoma (5%) cells. The patient underwent subtotal resection and received combination chemotherapy followed by radiotherapy and was alive 1 year after surgery.…”

“…Despite a male predominance, however, neonatal teratomas are more frequently diagnosed in females. 1,7 Teratomas of the brainstem are extremely rare. In the current series, we present 2 new cases of medulla oblongata teratomas that are exophytic and intraaxial, respectively, with significantly different outcomes.…”

“…In the current series, we present 2 new cases of medulla oblongata teratomas that are exophytic and intraaxial, respectively, with significantly different outcomes. Thus far, only 17 cases of primary brainstem germ cell tumor (GCT) have been reported (15 germinomas, 5 1 mixed GCT, 7 and 1 teratoma 9 ), with distinct characteristics in terms of age (mean age 24.2 years, range 12-40 years), ethnic group (all Asians), and histological subtypes (predominantly germinomas), 7,8 yet without consistent neuroradiological features.…”

“…7,9 The first case, reported by Tsuzuki et al, 9 was a 39-year-old male patient with a malignant teratoma of the medulla oblongata who underwent partial resection and chemoradiotherapy (the specific chemoradiotherapy regimen was not reported). However, the residual tumor regrew, and he died 3 months after surgery.…”

“…Teratoma is extremely rare in the brainstem and is seldom reported in children older than 2 years of age. 3,7 We report 2 cases of teratomas located exclusively in the medulla oblongata. To our knowledge, the cases we present here are the first 2 pediatric brainstem teratomas to be reported in the literature.…”