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Dyspnea and choking as presenting symptoms in primary medulla oblongata germinoma.

Yip CM, Tseng HH, Hsu SS, Liao WC, Chen JY, Chen CH, Chang CY - Surg Neurol Int (2014)

Bottom Line: The latest brain MRI and whole spine MRI done 1 year after surgery showed neither residual nor recurrent tumor in the whole axis.Intracranial germ cell tumors originate from extragonadal seminal cells and have been found in 0.4-3.4% of patients with primary central nervous system (CNS) tumors in Western countries, while the incidence is reported to be 5-8 times greater in Japan and the Far East.Although germinoma of medulla oblongata is rare and difficult to diagnose preoperatively, it should be included in the differential diagnosis of medulla masses with fourth ventricle extension, especially in Asian population.

View Article: PubMed Central - PubMed

Affiliation: Division of Neurosurgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R. O. C.

ABSTRACT

Background: The medulla oblongata is the lower half of the brainstem. It contains the cardiac, respiratory, vomiting, and vasomotor centers and deals with autonomic functions such as breathing, heartbeat, and blood pressure. Primary medulla oblongata germinoma is very rare and less than 20 cases have been reported in the English literature.

Case description: A 22-year-old female without any particular past medical history presented to us in October 2012 with the chief complaint of dyspnea and frequent choking for 1 month. Neurological examination revealed lower cranial nerve palsies and nystagmus. Her brain computed tomography (CT) and brain magnetic resonance imaging (MRI) demonstrated a mass lesion at the dorsal surface of medulla oblongata with extension into the inferior fourth ventricle and foramen magnum. She underwent bilateral suboccipital craniotomy and C1 laminoplasty with the grossly total resection of the tumor. The histological examination of the tumor proved germinoma. Postoperative adjuvant radiotherapy was arranged. The latest brain MRI and whole spine MRI done 1 year after surgery showed neither residual nor recurrent tumor in the whole axis. She is regularly followed-up at our outpatient department and is doing well except having left vocal cord palsy, which occurred before surgery.

Conclusion: Medulloblastoma, ependymoma, glioma, hemangioblastoma, and cavernous angioma are common intraaxial tumors in the medulla oblongata and fourth ventricle. Intracranial germ cell tumors originate from extragonadal seminal cells and have been found in 0.4-3.4% of patients with primary central nervous system (CNS) tumors in Western countries, while the incidence is reported to be 5-8 times greater in Japan and the Far East. Although germinoma of medulla oblongata is rare and difficult to diagnose preoperatively, it should be included in the differential diagnosis of medulla masses with fourth ventricle extension, especially in Asian population.

No MeSH data available.


Related in: MedlinePlus

Preoperative brain MRI. T1-weighted postcontrast image, sagittal (a), axial (b), coronal (c) views revealed a heterogeneous enhancing mass lesion with several foci of cystic change over inferior fourth ventricle, about 3.2 × 3 × 2.6 cm, and extension to foramen magnum, causing mild dilatation of fourth ventricle
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Figure 1: Preoperative brain MRI. T1-weighted postcontrast image, sagittal (a), axial (b), coronal (c) views revealed a heterogeneous enhancing mass lesion with several foci of cystic change over inferior fourth ventricle, about 3.2 × 3 × 2.6 cm, and extension to foramen magnum, causing mild dilatation of fourth ventricle

Mentions: A 22-year-old female without any particular past medical history presented to us in October 2012 with the chief complaint of dyspnea and frequent choking for 1 month. Traced back her clinical course, she had suffered from suboccipital pain, dizziness, and blurred vision for 6 months; about 2 months prior to the visit, she experienced dysarthria and intermittent swallowing disturbance. On admission, she was clear and ill-looking. Her neurological examination revealed left vocal cord palsy, weak gag reflex, tongue fasciculation, and horizontal nystagmus in the right side gaze. She had neither motor nor sensory disorder of her extremities and her Babinski's sign was negative on both sides. Magnetic resonance imaging (MRI) of brain was performed, which demonstrated a mass lesion about 3.2 × 3 × 2.6 cm in size located in the inferior fourth ventricle with extension to foramen magnum, causing mild dilatation of fourth ventricle. This tumor showed heterogeneous enhancement with several foci of cystic change in postgadolinium enhancement study [Figure 1]. The tentative diagnosis was medulloblastoma with the differential diagnosis of ependymoma.


Dyspnea and choking as presenting symptoms in primary medulla oblongata germinoma.

Yip CM, Tseng HH, Hsu SS, Liao WC, Chen JY, Chen CH, Chang CY - Surg Neurol Int (2014)

Preoperative brain MRI. T1-weighted postcontrast image, sagittal (a), axial (b), coronal (c) views revealed a heterogeneous enhancing mass lesion with several foci of cystic change over inferior fourth ventricle, about 3.2 × 3 × 2.6 cm, and extension to foramen magnum, causing mild dilatation of fourth ventricle
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109171&req=5

Figure 1: Preoperative brain MRI. T1-weighted postcontrast image, sagittal (a), axial (b), coronal (c) views revealed a heterogeneous enhancing mass lesion with several foci of cystic change over inferior fourth ventricle, about 3.2 × 3 × 2.6 cm, and extension to foramen magnum, causing mild dilatation of fourth ventricle
Mentions: A 22-year-old female without any particular past medical history presented to us in October 2012 with the chief complaint of dyspnea and frequent choking for 1 month. Traced back her clinical course, she had suffered from suboccipital pain, dizziness, and blurred vision for 6 months; about 2 months prior to the visit, she experienced dysarthria and intermittent swallowing disturbance. On admission, she was clear and ill-looking. Her neurological examination revealed left vocal cord palsy, weak gag reflex, tongue fasciculation, and horizontal nystagmus in the right side gaze. She had neither motor nor sensory disorder of her extremities and her Babinski's sign was negative on both sides. Magnetic resonance imaging (MRI) of brain was performed, which demonstrated a mass lesion about 3.2 × 3 × 2.6 cm in size located in the inferior fourth ventricle with extension to foramen magnum, causing mild dilatation of fourth ventricle. This tumor showed heterogeneous enhancement with several foci of cystic change in postgadolinium enhancement study [Figure 1]. The tentative diagnosis was medulloblastoma with the differential diagnosis of ependymoma.

Bottom Line: The latest brain MRI and whole spine MRI done 1 year after surgery showed neither residual nor recurrent tumor in the whole axis.Intracranial germ cell tumors originate from extragonadal seminal cells and have been found in 0.4-3.4% of patients with primary central nervous system (CNS) tumors in Western countries, while the incidence is reported to be 5-8 times greater in Japan and the Far East.Although germinoma of medulla oblongata is rare and difficult to diagnose preoperatively, it should be included in the differential diagnosis of medulla masses with fourth ventricle extension, especially in Asian population.

View Article: PubMed Central - PubMed

Affiliation: Division of Neurosurgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R. O. C.

ABSTRACT

Background: The medulla oblongata is the lower half of the brainstem. It contains the cardiac, respiratory, vomiting, and vasomotor centers and deals with autonomic functions such as breathing, heartbeat, and blood pressure. Primary medulla oblongata germinoma is very rare and less than 20 cases have been reported in the English literature.

Case description: A 22-year-old female without any particular past medical history presented to us in October 2012 with the chief complaint of dyspnea and frequent choking for 1 month. Neurological examination revealed lower cranial nerve palsies and nystagmus. Her brain computed tomography (CT) and brain magnetic resonance imaging (MRI) demonstrated a mass lesion at the dorsal surface of medulla oblongata with extension into the inferior fourth ventricle and foramen magnum. She underwent bilateral suboccipital craniotomy and C1 laminoplasty with the grossly total resection of the tumor. The histological examination of the tumor proved germinoma. Postoperative adjuvant radiotherapy was arranged. The latest brain MRI and whole spine MRI done 1 year after surgery showed neither residual nor recurrent tumor in the whole axis. She is regularly followed-up at our outpatient department and is doing well except having left vocal cord palsy, which occurred before surgery.

Conclusion: Medulloblastoma, ependymoma, glioma, hemangioblastoma, and cavernous angioma are common intraaxial tumors in the medulla oblongata and fourth ventricle. Intracranial germ cell tumors originate from extragonadal seminal cells and have been found in 0.4-3.4% of patients with primary central nervous system (CNS) tumors in Western countries, while the incidence is reported to be 5-8 times greater in Japan and the Far East. Although germinoma of medulla oblongata is rare and difficult to diagnose preoperatively, it should be included in the differential diagnosis of medulla masses with fourth ventricle extension, especially in Asian population.

No MeSH data available.


Related in: MedlinePlus