Akimoto Jiro, Murakami Mamoru, Fukami Shinjiro, Ikeda Yukio, Haraoka Jo
Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
J Clin Neurosci. 2009 May;16(5):705-8. doi: 10.1016/j.jocn.2008.06.009. Epub 2009 Mar 17.
We encountered 2 patients with germinoma arising from the medulla oblongata in whom preoperative radiological diagnosis was difficult. A 30-year-old woman presented due to aspiration pneumonia caused by bilateral lower cranial nerve palsies, and a 24-year-old man presented with headache caused by obstructive hydrocephalus. In both patients, there was a midline tumor that extended from the lower part of the fourth ventricle to the C1 lamina level. It was well-demarcated and homogeneously enhanced tumor with a slightly high density on plain CT scan. The preoperative diagnosis for both patients was ependymoma. The former patient had persistent lower cranial nerve palsies due to brain stem injury after tumor resection. Both patients achieved complete remission with adjuvant therapy. Fewer than 10 cases of germinoma affecting the medulla oblongata have been reported. Radiological findings resembling those of the pineal region germinoma were observed in the two patients reported here. We would like to stress the importance of remembering germinoma when making a preoperative differential diagnosis of fourth ventricular tumors in young adults.
我们遇到了2例起源于延髓的生殖细胞瘤患者，术前放射学诊断困难。一名30岁女性因双侧下颅神经麻痹导致吸入性肺炎就诊，一名24岁男性因梗阻性脑积水导致头痛就诊。两名患者均有中线肿瘤，从第四脑室下部延伸至C1椎板水平。这是一个边界清晰、均匀强化的肿瘤，在平扫CT上密度略高。两名患者术前诊断均为室管膜瘤。前一名患者在肿瘤切除后因脑干损伤而持续存在下颅神经麻痹。两名患者经辅助治疗后均实现完全缓解。报道了不到10例累及延髓的生殖细胞瘤病例。在此报道的两名患者中观察到了类似于松果体区生殖细胞瘤的放射学表现。我们想强调在对年轻成人第四脑室肿瘤进行术前鉴别诊断时记住生殖细胞瘤的重要性。
