Dyspnea and choking as presenting symptoms in primary medulla oblongata germinoma

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

Background

Intracranial germinomas are rare tumors, accounting for 0.5-2% of primary intracranial neoplasms. While they typically occur in the pineal gland, suprasellar region, basal ganglia, and thalamus, germinomas arising in the medulla oblongata are exceptionally rare. Diagnosis of medulla oblongata germinoma is challenging, potentially leading to misdiagnosis and poor prognosis.

Case Description

We present a case of a 29-year-old man complaining of left leg numbness. Radiological findings revealed a contrast-enhanced lesion in the medulla oblongata. The patient underwent tumor biopsy, and intraoperative pathological diagnosis (IOD) suspected the diagnosis of medulla oblongata germinoma. He underwent chemoradiotherapy after confirming the diagnosis of germinoma. Intracranial germinoma arising in the medulla oblongata differs from germinomas in other locations due to its higher incidence in individuals in their 20s and a slight female predominance.

Conclusion

When encountering lesions in the medulla oblongata, germinoma should be considered as one of the differential diagnoses, and surgical strategies including IOD should be planned accordingly.

Mixed Germ Cell Tumor with a Yolk Sac Tumor Component in the Medulla Oblongata of a 50-year-old Patient: A Case Report and Literature Review

Yolk sac tumor (YST) is a rare primary brain tumor that occurs almost exclusively in patients under 30 years old. Intracranial germ cell tumors are most frequently located in the pineal and suprasellar region. Medulla oblongata YSTs are particularly rare. Extragonadal YSTs may be difficult to diagnose because of their characteristics, such as the rarity and variety of growth patterns. Furthermore, they are known to have a very poor prognosis. We herein report a case of YST of the medulla oblongata in a 50-year-old woman. She was followed up for 18 months without any tumor recurrence.

Primary germinoma of the medulla oblongata: illustrative case

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.

Mass brain tissue lost after decompressive craniectomy: A case report

BACKGROUND

The brain is the most important organ to maintain life. However, the amount of brain tissue required for maintaining life in humans has not been previously reported.

CASE SUMMARY

A 33-year-old woman fell from the third floor three months before admission to our department. She received a decompressive craniectomy soon after injury. After the operation, operative incision disunion occurred due to the high pressure. Brain tissue flowed from the incision, and intracranial infection occurred. She fell into deep coma and was sent to our hospital. Her right temporal surgical incision was not healed and had a cranial defect of 10 cm × 10 cm. Her intracranial cavity was observed from the skull defect, and the brain tissue was largely lost. In addition, no brain tissue was observed by visual inspection. Cranial computed tomography showed that only a small amount of brain tissue density shadow was compressed in the cerebellum and brainstem. Four days after hospitalization in our hospital, her parents transferred her to a hospital near her hometown. The patient died six days after discharge from our hospital.

CONCLUSION

This rare case provides some proof of the importance of the brainstem in the maintenance of cardiac rhythm and vascular tension. Neurosurgeons should carefully protect brainstem neurons during operations. Clinicians can maintain the cardiac rhythm of patients who lose their major brain tissue with modern technology, but the family of the patients should be aware of death and end-life care.

A Rare Case of Intra-Fourth-Ventricular Germinoma, Derived from the Medulla Oblongata

INTRODUCTION

Extragonadal germinomas rarely emerge from the brain stem; however, proper diagnosis and treatment can result in favorable prognosis. Unfortunately, the preoperative diagnosis of medulla oblongata germinoma is difficult due to insufficient clinical signs and symptoms that are specific to this diagnosis. Case Representation: We present a 12-year-old male patient with an intra-fourth-ventricular germinoma, derived from the medulla oblongata, with no abnormalities in the supratentorial region. The germinoma was initially assessed by advance MRI sequences, including diffusion-weighted imaging, T1 perfusion, and spectroscopy.

CONCLUSION

In summary, although existing imaging technologies cannot completely distinguish germinomas from other primary brain neoplasms in the fourth ventricle, in patients aged between 12 and 40 years, a small mass on the dorsal side of medulla oblongata that emerges into the fourth ventricle and is characterized by homogeneous contrast enhancement, the absence of calcification and hemorrhage, and the lack of hydrocephalus should be considered for a potential medulla oblongata germinoma diagnosis.

Primary cavernous sinus germinoma with atypical extension pattern: a case report and review of the literature

Primary intracranial germinoma is a rare central nervous system tumor that usually arises in the pineal and the supra-sellar region. Here, we report a rare case of primary intracavernous sinus germinoma with an atypical extension pattern, with a comparison to germinomas originating from the cavernous sinus as described in the existing literature. A 12-year-old boy was admitted to our hospital with the chief complaint of the left-side ptosis and double vision. Magnetic resonance imaging showed homogenous enhanced mass lesion in the pineal region together with mass lesions in the lateral ventricle, left cavernous sinus, and temporal lobe, extending into the left masticator space. The enhanced mass in the intracavernous sinus originated from the cavernous sinus. Endoscopic third ventriculostomy and tumor biopsy was done. Pathological diagnosis was pure germinoma. After six courses of chemotherapy followed by radiation therapy, all the lesions decreased in size significantly. Only faint enhancement around the masticator space remained. We report a rare case of a germinoma that developed mainly in the cavernous sinus with additional tumor masses in the pineal region, ventricles, and temporal lobe. Although the lesions shrank significantly on the post-chemoradiation imaging, a long follow-up is necessary not only to check for symptoms, but also monitor imaging findings for possible serial changes in the residual region of the masticator space.

Successful microvascular decompression surgery for dolichoectatic vertebral artery compression of medulla oblongata in a patient with hypersomnia disorder

INTRODUCTION

Hypersomnia is a condition in which a person has trouble staying awake during the day. There are several potential causes of it, including sleep apnea and sleep disorders.

CASE PRESENTATION

A 43 year old male was referred to our practice with complaints of hypersomnia, snoring, slurred speech and sleep apnea for more diagnostic and therapeutic interventions. His brain MRI was significant for a vascular loop compression on medulla oblongata. The patient underwent microvascular decompression surgery subsequently and showed improvement in all of his symptoms.

CONCLUSION

One of the rare causes of sleep apnea is medulla oblongata compression by a vascular loop. Vertebrobasilar dolichoectasia may cause this phenomenon probably and should be reviewed in imaging examinations more precisely. Microvascular decompression by using a synthetic Teflon patch may be helpful in management of these patients.

Immunohistochemical Localization of Somatostatin in the Brain of Chinese Alligator Alligator sinensis

In this study, the regional distribution and histological localization of somatostatin (SS) immunoreactive (IR) perikarya and fibers was investigated for the first time in the brain of adult Chinese alligator by immunohistochemical method. The results showed SS-IR perikarya and fibers were widely distributed in various parts of the brain except for olfactory bulbs. In the telencephalon, SS-IR perikarya were predominantly located in the cellular layer and deep plexiform layer of dorsomedial and medial cortex, less in the dorsal and lateral cortex, while SS-IR fibers were found in all layers of the cerebral cortex. SS-IR perikarya and fibers were also detected in the dorsal ventricular ridge, hippocampus cortex, accessory olfactory bulb nuclearus, lenticular nucleus, and caudate nucleus. In the diencephalon, SS-IR perikarya and fibers were mainly present in supraoptic nucleus, paraventricular nucleus of hypothalamus, recessus infundibular nucleus, median eminence, the pineal gland and pituitary gland, in which the IR-fibers were abundant, appearing dot-shaped and varicosity-like. In the mesencephalon, they were present in tectum cortex, ependyma of cerebral aqueduct and the periaqueductal grey matter. Additionally, they were also detected in Purkinje's cellular layer of cerebellum, in the reticularis nucleus and raphe nucleus of medulla oblongata. The distribution pattern of SS-IR perikarya and fibers in the brain of Chinese alligator is generally similar to that reported in other reptiles, but also has some specific features. The wide distribution indicated that SS might be a neurotransmitter or neuromodulator which acts on many kinds of target cells with a wide range of physiological functions. Anat Rec, 300:507-519, 2017. © 2016 Wiley Periodicals, Inc.