Primary germinoma of the medulla oblongata: illustrative case

Abstract

BACKGROUND Primary central nervous system germinomas of the medulla oblongata are extremely rare and usually have been found in young female Asian patients. The authors present an illustrative case of a patient who presented with severe medullary and posterior cord syndrome, the first South American case published to date, to the authors’ knowledge. OBSERVATIONS Initially, the radiological differential diagnosis did not include this entity. The lesion was located at the obex and exhibited a well-delineated contrast enhancement without hydrocephalus. An emergency decompressive partial resection following functional limits was performed. After histological confirmation, radiotherapy was indicated, with complete remission achieved at a 6-month follow-up. The patient, however, continued to have a severe proprioceptive disorder. The literature review identified 21 other such patients. The mean age for this location was 23 years, with a strong female and Asian origin predilection. All tumors exhibited contrast enhancement, and only one presented with hydrocephalus. LESSONS In the absence of elevated tumor markers, radiological clues such as a well-delineated, contrast-enhanced lesion arising from the obex, without hydrocephalus, associated with demographic features such as young age, female sex, and Asian heritage, should evoke a high level of suspicion for this diagnosis. Gross total resection must not be attempted, because this tumor is potentially curable with high-dose radiotherapy.

A Case of Multifocal Ectopic Germinoma Manifesting with Medial Longitudinal Fasciculus Syndrome

“…For brainstem lesions, 22 cases of medullary germinomas have been reported [ 11 ]. These cases, predominantly observed in East Asia, are often present as cystic lesions with heterogeneous components on imaging.…”

Histopathological, Demographic, and Clinical Signatures of Medulla Oblongata Germ Cell Tumors: A Case Report With the Review of Literature

“…This study examined the literature for clinical and histopathological findings of GCTs arising at the medulla oblongata [ 26 - 54 ]. This study aimed to elucidate the characteristic features of this atypical occurrence compared to those of GCTs arising from typical locations.…”

Preoperatively difficult-to-diagnose medulla oblongata germinoma: A case report and literature review

“…[ 2 ] Although extremely rare, germinomas can also arise in the medulla oblongata. [ 1 , 2 , 4 , 6 - 9 , 12 - 26 , 28 - 32 ] Preoperative diagnosis of germinoma in the medulla oblongata is difficult due to tumor rarity, and there have been reported cases where misdiagnosis led to poor prognosis.…”

“…[10,11,19] e most common site of occurrence for germinomas is the pineal region (45%), followed by the suprasellar region (32%), and the basal ganglia and thalamus (13%). [2] Although extremely rare, germinomas can also arise in the medulla oblongata. [1,2,4,[6][7][8][9][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][28][29][30][31][32] Preoperative diagnosis of germinoma in the medulla oblongata is difficult due to tumor rarity, and there have been reported cases where misdiagnosis led to poor prognosis.…”

“…[2] Although extremely rare, germinomas can also arise in the medulla oblongata. [1,2,4,[6][7][8][9][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][28][29][30][31][32] Preoperative diagnosis of germinoma in the medulla oblongata is difficult due to tumor rarity, and there have been reported cases where misdiagnosis led to poor prognosis. magnetic resonance (MR) imaging at a local medical facility.…”